| Doctor Name: | MS. LAURI B.A. MOFFATT |
| NPI Number: | 1841529088 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD,SLP, MA, CCC |
| License Number: | 12189 |
| Business Practice Address: | 180 N. Jackson Ave San Jose, CA - 95116 |
| Business Phone Number: | 9712065200 |
| Business Fax Number: | 9712065203 |
| Mailing Address: | 4560 Se International Way, Ste 100 MILWAUKIE |
| State: | OR |
| Postal Code: | 97222 |
| Phone Number: | 9712065200 |
| Fax Number: | 9712065203 |
| NPI Enumeration Date: | 12/17/2009 |
| NPI Last Update Date: | 12/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 12189 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| 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 |