Doctor Name: | MRS. MISTI NICOLE MOON |
NPI Number: | 1093082026 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 3654 |
Business Practice Address: | 6905 Nw 122nd St Oklahoma City, OK - 731423903 |
Business Phone Number: | 4056036622 |
Business Fax Number: | |
Mailing Address: | 14429 Ashwood Ct, EDMOND |
State: | OK |
Postal Code: | 730252240 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/18/2011 |
NPI Last Update Date: | 03/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3654 |
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 |