Individual
MALLORY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
2309 S SERVICE RD W, RUSTON, LA 71270-3167
(318) 232-1969
Mailing address
PO BOX 1377, WEST MONROE, LA 71294-1377
(318) 396-1969
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8340
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8340
SPEECH LICENSE
LA
Enumeration date
07/31/2019
Last updated
07/31/2019
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