Individual
ELYSE RENEE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
12218 STAGECOACH RD, HICKMAN, NE 68372-7011
(402) 217-5541
Mailing address
12218 STAGECOACH RD, HICKMAN, NE 68372-7011
(402) 217-5541
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14049670
AMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
—
Enumeration date
06/19/2018
Last updated
11/07/2023
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