Individual
DR. MARY ELLEN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH D
Contact information
Practice address
2648 W PERSHING RD, CHICAGO, IL 60632-1629
(312) 806-1885
Mailing address
2648 W PERSHING RD, CHICAGO, IL 60632-1629
(312) 806-1885
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071002095
IL
Other
Enumeration date
10/18/2006
Last updated
05/20/2020
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