Individual
MRS. MISTI NICOLE MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6905 NW 122ND ST, OKLAHOMA CITY, OK 73142-3903
(405) 603-6622
Mailing address
14429 ASHWOOD CT, EDMOND, OK 73025-2240
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3654
OK
Other
Enumeration date
11/18/2011
Last updated
03/23/2016
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