Provider Demographics
NPI:1417367897
Name:MOORE, HOLLY KEBODEAUX (L-SLP; CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:KEBODEAUX
Last Name:MOORE
Suffix:
Gender:F
Credentials:L-SLP; CCC-SLP
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:DANIELLE
Other - Last Name:KEBODEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PL-SLP; CF-SLP
Mailing Address - Street 1:PO BOX 1462
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-1462
Mailing Address - Country:US
Mailing Address - Phone:318-953-1380
Mailing Address - Fax:318-322-8290
Practice Address - Street 1:211 N 3RD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6731
Practice Address - Country:US
Practice Address - Phone:318-322-8974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist