Most Relevant Information
Provider Data
| NPI Number: | 1003066978 |
| Provider Name: | DANIELLE MOORE CCC-SLP |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | SLP004369 |
Most Important Dates
| Enumeration Date: | 09/26/2008 |
| Last Updated: | 09/26/2008 |
Provider Practice Location
3756 LAVISTA RD
SUITE 104
TUCKER
GA
300845614
Practice Location Phone/Fax
| Phone: | 4044779400 |
| Fax: |
Provider Mailing Location
405 JORDAN DR
TUCKER
GA
300842035
Provider Mailing Phone/Fax
| Phone: | 4044779400 |
| Fax: |