Provider Demographics
NPI:1669810818
Name:MOORE, DARYL DENISE (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:DARYL
Middle Name:DENISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7919 SPRING FLOWER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5634
Mailing Address - Country:US
Mailing Address - Phone:803-736-4639
Mailing Address - Fax:
Practice Address - Street 1:7919 SPRING FLOWER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5634
Practice Address - Country:US
Practice Address - Phone:803-736-4639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist