Provider Demographics
NPI:1447492293
Name:MOORE, AMY C (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:LIVINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:152 BELLE MEADE DR
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-4006
Mailing Address - Country:US
Mailing Address - Phone:251-363-6213
Mailing Address - Fax:
Practice Address - Street 1:403 FORREST AVE
Practice Address - Street 2:
Practice Address - City:EAST BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-2622
Practice Address - Country:US
Practice Address - Phone:251-363-6213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist