Individual
MS. LISA KAY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSE CCC SLP
Contact information
Practice address
1301 W MAIN ST, JACKSONVILLE, AR 72076-4326
(501) 982-2128
Mailing address
1301 W MAIN ST, JACKSONVILLE, AR 72076-4326
(501) 982-2128
Taxonomy
Speciality
Code
Description
License number
State
235500000X
Speech/Language/Hearing Specialist/Technologist
611
AR
235Z00000X
Speech-Language Pathologist
Primary
611
AR
235Z00000X
Speech-Language Pathologist
SP611
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139362721
—
AR
Enumeration date
01/22/2009
Last updated
08/25/2025
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