Provider Demographics
NPI:1720171903
Name:MOODY, FELICIA ROBINSON (SLP)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:ROBINSON
Last Name:MOODY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:S
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9120 WILLOW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8313
Mailing Address - Country:US
Mailing Address - Phone:704-266-6289
Mailing Address - Fax:
Practice Address - Street 1:9120 WILLOW RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8313
Practice Address - Country:US
Practice Address - Phone:704-266-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist