Individual
KENNETH MOSES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
237 GREENLEAF ST, EVANSTON, IL 60202-1467
(847) 778-2197
Mailing address
237 GREENLEAF ST, EVANSTON, IL 60202-1467
(847) 778-2197
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
71-1630
IL
Other
Enumeration date
07/04/2021
Last updated
07/04/2021
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