Provider Demographics
NPI:1619861143
Name:MOORE, MARTINE EXUMAT (MS, SLP)
Entity type:Individual
Prefix:
First Name:MARTINE
Middle Name:EXUMAT
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BURR OAK LN
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-7356
Mailing Address - Country:US
Mailing Address - Phone:864-354-2064
Mailing Address - Fax:
Practice Address - Street 1:500 DOWNS LOOP
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2035
Practice Address - Country:US
Practice Address - Phone:864-654-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSLP.8961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist