Provider Demographics
NPI:1336578236
Name:MOYER, KATLIN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATLIN
Middle Name:
Last Name:MOYER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:KATLIN
Other - Middle Name:
Other - Last Name:FLEISCHUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427-9401
Mailing Address - Country:US
Mailing Address - Phone:267-994-4470
Mailing Address - Fax:
Practice Address - Street 1:120 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427-9401
Practice Address - Country:US
Practice Address - Phone:267-994-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist