Provider Demographics
NPI:1205578887
Name:MOORE, CECILIA KATHLEEN
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:KATHLEEN
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6784 AUTUMNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-3943
Mailing Address - Country:US
Mailing Address - Phone:615-517-9722
Mailing Address - Fax:
Practice Address - Street 1:1880 GENERAL GEORGE PATTON DR STE 202B
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6429
Practice Address - Country:US
Practice Address - Phone:615-377-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist