Provider Demographics
NPI:1104705342
Name:MOORE, ARLISS J
Entity type:Individual
Prefix:
First Name:ARLISS
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 S CHOCTAW ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-8591
Mailing Address - Country:US
Mailing Address - Phone:832-474-6103
Mailing Address - Fax:
Practice Address - Street 1:100 CHERRY CREEK RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-1301
Practice Address - Country:US
Practice Address - Phone:936-258-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121624235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist