Stephanie Anne Moore, M.A., CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7555 Issued in SC

Practice address

117 Spratt St Ste B
Fort Mill, SC 29715-4111

Phone

(704) 931-1010

NPI assigned

Nov 17, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Stephanie Anne Jenkins Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Therapy Resource Group

  • Mental Health Counselor
  • Fort Mill, SC
  • NPI 1578133781
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1326375015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 SPRATT ST STE B",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297154111",
            "telephone_number": "704-931-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 SPRATT ST STE B",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297154111",
            "telephone_number": "704-931-1010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "926 Oakland Ave",
            "address_purpose": "LOCATION",
            "city": "Rock Hill",
            "state": "SC",
            "postal_code": "297303552",
            "country_code": "US",
            "telephone_number": "704-931-1010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "STEPHANIE",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "M.A., CCC/SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-17",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "9245",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "7555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF SOUTH CAROLINA",
            "identifier": "7555",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "JENKINS",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Speech-Language Pathologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.