Individual
CARLA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
52 TREEHOUSE RD, MATTESON, IL 60443-1262
(708) 748-5901
Mailing address
52 TREEHOUSE RD, MATTESON, IL 60443-1262
(708) 748-5901
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146006348
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146006348
DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION DIVISION OF PROFESSIONAL REG
IL
01
—
82922
EDUCATOR CERTIFICATION SYSTEM
IL
Enumeration date
01/04/2013
Last updated
01/04/2013
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