Individual
KELLY M MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5000 S 5TH AVE, HINES, IL 60141-3030
(708) 774-0246
Mailing address
900 S CLARK ST APT 904, CHICAGO, IL 60605-3686
(719) 648-7617
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071008849
IL
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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