Individual
MARK DANIEL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA SCHOOL PSYCHOLOGY
Contact information
Practice address
100 MINER ST, CRESCENT CITY, IL 60928-8092
(815) 683-2662
Mailing address
100 MINER ST, CRESCENT CITY, IL 60928-8092
(815) 683-2662
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1986210
IL
Other
Enumeration date
08/30/2017
Last updated
07/21/2022
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