Individual
JUSTIN ANTHONY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 CENTRAL AVE STE 220, NORTHFIELD, IL 60093-3024
(847) 996-9994
Mailing address
1189 WILMETTE AVE STE 263, WILMETTE, IL 60091-2719
(224) 216-4443
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3606-57
WI
Other
Enumeration date
06/22/2016
Last updated
12/01/2023
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