Individual
DOREEN R. MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.CCC-SLP
Contact information
Practice address
63 ELM STREET, HEARTLAND, ME 04943
(207) 368-5146
(207) 368-2192
Mailing address
30 CATELL ST, BANGOR, ME 04401-6802
(207) 990-2093
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP789
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP789
SPEECH-LANGUAGE PATHOLOGY
ME
Enumeration date
09/10/2010
Last updated
09/10/2010
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