Provider Demographics
NPI:1881839991
Name:MOORE, BRANDI L (SLP-CFY)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13170 DUTCHTWN PT AVE
Mailing Address - Street 2:APT 2721
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-0101
Mailing Address - Country:US
Mailing Address - Phone:504-666-0077
Mailing Address - Fax:
Practice Address - Street 1:13170 DUTCHTWN PT AVE
Practice Address - Street 2:APT 2721
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-0101
Practice Address - Country:US
Practice Address - Phone:504-666-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist