Provider Demographics
NPI:1962831347
Name:MOORE, MARYKATE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARYKATE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MARYKATE
Other - Middle Name:
Other - Last Name:REMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 OAK CIR
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3833
Mailing Address - Country:US
Mailing Address - Phone:215-837-2896
Mailing Address - Fax:
Practice Address - Street 1:2751 DEKALB PIKE
Practice Address - Street 2:SUBURBAN WOODS REHABILITATION
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1820
Practice Address - Country:US
Practice Address - Phone:610-278-2700
Practice Address - Fax:610-275-3398
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist