Provider Demographics
NPI:1740573732
Name:MOORE, LAURA BETH (MS CFY-SLP)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:BETH
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 E WILSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2474
Mailing Address - Country:US
Mailing Address - Phone:630-761-0900
Mailing Address - Fax:630-761-0909
Practice Address - Street 1:1049 E WILSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2474
Practice Address - Country:US
Practice Address - Phone:630-761-0900
Practice Address - Fax:630-761-0909
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist