Individual
JOHN MOORE FOGARTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
125 E 13TH ST UNIT 911, CHICAGO, IL 60605-2675
(440) 391-3995
Mailing address
125 E 13TH ST UNIT 911, CHICAGO, IL 60605-2675
(440) 391-3995
(888) 243-3903
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/10/2021
Last updated
11/10/2021
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