Provider Demographics
NPI:1750975934
Name:MORON, JAMIE ELISE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ELISE
Last Name:MORON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ELISE
Other - Last Name:COOMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:15413 LEEDS LN
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77040-1340
Mailing Address - Country:US
Mailing Address - Phone:281-728-6990
Mailing Address - Fax:
Practice Address - Street 1:815 S VOSS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1031
Practice Address - Country:US
Practice Address - Phone:713-827-0883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist