Suzanne Michelle Moore

Primary specialty

Social WorkerTaxonomy code 104100000X

License

SM1219 Issued in OR

Practice address

722 NE 162ND Ave
Portland, OR 97230-5760

Phone

(503) 515-5566

Fax

(503) 261-0988

NPI assigned

Aug 14, 2008

Last updated

Jul 29, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1218672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280361600000",
    "number": "1467608083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 NE SOUTH SHORE RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972111132",
            "telephone_number": "503-302-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 NE 162ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972305760",
            "telephone_number": "503-515-5566",
            "fax_number": "503-261-0988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SUZANNE",
        "middle_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-14",
        "last_updated": "2010-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OR",
            "license": "SM1219",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OR",
            "license": "SM1219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryann Mishell Moore, LCSW
• Sarah Ellen Moore, M.D.
• Stephanie Cherie Moore, RD, CD
• Stephen Moore
• Steve Moore, PHD, MS, MBA, FACMG
• Tasha Ann Moore, QMHA
• Tieara Elizabeth Moore
• Tracy Moore, RD
• Tyna Lee Moore, N.D., D.C.
• Vicki Darlene Moore, RN, MSN, ACNP

• Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; 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.