Amy Marie Moomaw, CCC.SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202003817 Issued in VA

Practice address

6401 Auburn Dr
Virginia BCH, VA 23464-3601

Phone

(757) 420-1485

NPI assigned

May 4, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359763200000",
    "number": "1902018807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1214 REDGATE AVE",
            "address_2": "APT D",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071344",
            "telephone_number": "757-303-8219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 AUBURN DR",
            "city": "VIRGINIA BCH",
            "state": "VA",
            "postal_code": "234643601",
            "telephone_number": "757-420-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOMAW",
        "first_name": "AMY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "CCC.SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2013-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202003817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2013; 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.