Individual
KEONA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2845 E 77TH ST APT 110, CHICAGO, IL 60649-4830
(708) 439-0832
Mailing address
2845 E 77TH ST APT 110, CHICAGO, IL 60649-4830
(708) 439-0832
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
08/18/2016
Last updated
08/18/2016
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