Provider Demographics
NPI:1306169404
Name:MOORE, KATE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N HAYDEN RD
Mailing Address - Street 2:#3039
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1758
Mailing Address - Country:US
Mailing Address - Phone:248-787-2194
Mailing Address - Fax:
Practice Address - Street 1:1402 E SOUTH MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-7925
Practice Address - Country:US
Practice Address - Phone:602-708-5064
Practice Address - Fax:602-218-3212
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist