Individual
TERRENA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
707 W WAVELAND AVE, APT. 405, CHICAGO, IL 60613-4188
(773) 297-3735
Mailing address
707 W WAVELAND AVE, APT. 405, CHICAGO, IL 60613-4188
(773) 297-3735
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/14/2015
Last updated
04/14/2015
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