Doctor Name: | JENNIFER MOODY |
NPI Number: | 1215286067 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. CCC-SLP |
License Number: | 021312 |
Business Practice Address: | 435 4th St Troy, NY - 121805324 |
Business Phone Number: | 8457027789 |
Business Fax Number: | |
Mailing Address: | 16 Edison Ave, ALBANY |
State: | NY |
Postal Code: | 122082429 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/06/2012 |
NPI Last Update Date: | 08/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 021312 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
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 |