Individual
ANGELA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
519 W 2ND ST, GENOA, IL 60135-1058
(815) 517-3101
Mailing address
507 W MAIN ST APT 1, KIRKLAND, IL 60146-8453
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588395362
—
IL
Enumeration date
10/20/2016
Last updated
07/22/2025
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