Provider Demographics
NPI:1942475371
Name:MOORE, KATHERINE LOUISE (AUD)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LOUISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:LOUISE
Other - Last Name:GOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:454 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-2249
Mailing Address - Country:US
Mailing Address - Phone:330-334-1249
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-421-3047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-27
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01658231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist