Individual
SHANNON LYNN MOOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, ROT, LAT
Contact information
Practice address
255 RED GATE RD, ST CHARLES, IL 60175-6396
(224) 805-1199
Mailing address
708 CHIPPEWA DR, NAPERVILLE, IL 60563-1387
(224) 805-1199
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096004184
IL
Other
Enumeration date
10/23/2024
Last updated
10/23/2024
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