Provider Demographics
NPI:1861506875
Name:MOORE, CAROLINE SYKES (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:SYKES
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W CHIPPENDALE DR
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-8517
Mailing Address - Country:US
Mailing Address - Phone:828-231-9633
Mailing Address - Fax:
Practice Address - Street 1:4020 HENDERSONVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-8251
Practice Address - Country:US
Practice Address - Phone:828-687-9559
Practice Address - Fax:828-687-8428
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136F9OtherBCBSNC
NC7412462Medicaid