Provider Demographics
NPI:1225365885
Name:MORIARTY, DAWN M (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27182 GALVEZ LN
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6218
Mailing Address - Country:US
Mailing Address - Phone:770-401-6210
Mailing Address - Fax:
Practice Address - Street 1:27182 GALVEZ LN
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6218
Practice Address - Country:US
Practice Address - Phone:770-401-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24523235Z00000X
GASLP004087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist