| Doctor Name: | MS. JILL DIMOND MOORE |
| NPI Number: | 1033382478 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, C.C.C. |
| License Number: | 239 |
| Business Practice Address: | 4401 S Western Ave Dept. 2004215 Oklahoma City, OK - 731093413 |
| Business Phone Number: | 4056367131 |
| Business Fax Number: | 4056445476 |
| Mailing Address: | 4401 S Western Ave, Dept. 2004215 OKLAHOMA CITY |
| State: | OK |
| Postal Code: | 731093413 |
| Phone Number: | 4056367131 |
| Fax Number: | 4056445476 |
| NPI Enumeration Date: | 04/07/2008 |
| NPI Last Update Date: | 04/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 239 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |