Individual
MELISSA MARIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1192 MOORE RD, VAUGHAN, MS 39179-9486
(662) 673-2289
(662) 673-9607
Mailing address
1192 MOORE RD, VAUGHAN, MS 39179-9486
(662) 673-2289
(662) 673-9607
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S2150
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09972277
—
MS
Enumeration date
04/13/2007
Last updated
07/08/2007
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