Provider Demographics
NPI:1912163999
Name:MOORE, BRITTNEY MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 SW SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7582
Mailing Address - Country:US
Mailing Address - Phone:479-254-8639
Mailing Address - Fax:
Practice Address - Street 1:435 W CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-8701
Practice Address - Country:US
Practice Address - Phone:479-795-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1955235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR12025087OtherASHA
AR1955OtherARKANSAS BOARD OF EXAMINERS IN SPEECH-LANGUAGE PATHOLOGY