Provider Demographics
NPI:1972844678
Name:MOORE, ANDREA GRAHAM (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:GRAHAM
Last Name:MOORE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W BAKER RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2398
Mailing Address - Country:US
Mailing Address - Phone:866-659-2295
Mailing Address - Fax:281-420-9465
Practice Address - Street 1:901 W BAKER RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2398
Practice Address - Country:US
Practice Address - Phone:866-659-2295
Practice Address - Fax:281-420-9465
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10174235Z00000X
TX113188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist