Provider Demographics
NPI:1679098768
Name:MOORE, JAN ALLISON (PHD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:ALLISON
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 M AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-1563
Mailing Address - Country:US
Mailing Address - Phone:308-224-3229
Mailing Address - Fax:308-865-8397
Practice Address - Street 1:1615 W 24TH STREET
Practice Address - Street 2:UNK SPEECH & HEARING CLINIC
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68849
Practice Address - Country:US
Practice Address - Phone:308-865-8301
Practice Address - Fax:308-865-8397
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE267231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist