Provider Demographics
NPI:1306072228
Name:MOORE, JANET HAZEN (MS, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:HAZEN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:MRS
Other - First Name:JANET
Other - Middle Name:LEIGH
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:5512 AZALEA LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-2703
Mailing Address - Country:US
Mailing Address - Phone:318-443-5719
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HWY
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4983237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter