Provider Demographics
NPI:1740779297
Name:MOORE, JOCELYN (SLP)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361723
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30036-1723
Mailing Address - Country:US
Mailing Address - Phone:888-273-8628
Mailing Address - Fax:888-273-8628
Practice Address - Street 1:4319 COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1210
Practice Address - Country:US
Practice Address - Phone:888-273-8628
Practice Address - Fax:888-273-8628
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009667235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist