Provider Demographics
NPI:1356972574
Name:MOORE, ALYSSA
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
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:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:BERNICE
Mailing Address - State:LA
Mailing Address - Zip Code:71222-0481
Mailing Address - Country:US
Mailing Address - Phone:318-478-2270
Mailing Address - Fax:
Practice Address - Street 1:2309 S SERVICE RD W
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3167
Practice Address - Country:US
Practice Address - Phone:318-232-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7052235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist