Individual
LYDIA JEANETTE MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
3851 COMMERCIAL CENTER DR, LADSON, SC 29456-4146
(843) 314-5434
Mailing address
3851 COMMERCIAL CENTER DR, LADSON, SC 29456-4146
(843) 314-5434
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7249
SC
235Z00000X
Speech-Language Pathologist
SA16049
FL
Other
Enumeration date
09/28/2018
Last updated
07/08/2020
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