Individual
KELLY MOOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1316 S BARKSDALE RD, MT PLEASANT, SC 29464-5165
(843) 822-8277
Mailing address
1316 S BARKSDALE RD, MT PLEASANT, SC 29464-5165
(843) 822-8277
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4130
SC
Other
Enumeration date
07/02/2013
Last updated
07/02/2013
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