Provider Demographics
NPI:1952646457
Name:MOODY, BARBARA R (HIS)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:R
Last Name:MOODY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 W. PALMER ST.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ARTHUR
Mailing Address - State:IL
Mailing Address - Zip Code:61911
Mailing Address - Country:US
Mailing Address - Phone:217-543-4526
Mailing Address - Fax:
Practice Address - Street 1:431 W PALMER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ARTHUR
Practice Address - State:IL
Practice Address - Zip Code:61911-1216
Practice Address - Country:US
Practice Address - Phone:217-543-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL2776237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist