NPI | 1780948729 |
---|---|
Former Name | AMANDA MOODY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: SC 5342) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AZ TSLP7816) |
Enumeration Date | 2012-06-25 |
Last Update Date | 2013-09-03 |