Provider Demographics
NPI:1699123851
Name:MOORE, ANNA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
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 1:7 DUXFORD LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-4805
Mailing Address - Country:US
Mailing Address - Phone:479-402-5162
Mailing Address - Fax:
Practice Address - Street 1:956 MATHIAS DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0985
Practice Address - Country:US
Practice Address - Phone:479-419-9911
Practice Address - Fax:479-419-5595
Is Sole Proprietor?:No
Enumeration Date:2016-05-28
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist