Doctor Name: | ELISABETH ANNE MOODY |
NPI Number: | 1558389718 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCC-SLP |
License Number: | SA5418 |
Business Practice Address: | 111 Nature Walk Pkwy Suite 101 St. Augustine, FL - 32092 |
Business Phone Number: | 9042307761 |
Business Fax Number: | 9042307763 |
Mailing Address: | 6423 Dartmouth Rd, JACKSONVILLE |
State: | FL |
Postal Code: | 322172483 |
Phone Number: | 9042307761 |
Fax Number: | |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA5418 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
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 |