Individual
JENNA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1450 BUSCH PKWY, SUITE 115A, BUFFALO GROVE, IL 60089-4541
(224) 676-7920
Mailing address
8930 WAUKEGAN RD, SUITE 200, MORTON GROVE, IL 60053-2126
(847) 324-3976
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096-003230
IL
Other
Enumeration date
06/12/2012
Last updated
06/12/2012
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