Mary Ellen Moore PH D

NPI 1487735940 - Psychologist - 103TC0700X

NPI Details
NPI 1487735940
Gender Female
Enumeration Date 10/18/2006
Last Updated 09/21/2012
Entity Type Individual
Active Over 10 years ago
Practice Location
5536 S EVERETT AVE
CHICAGO IL, 60637, US
Phone (773) 643-6259
Fax (773) 643-6929
Business Location
4721 J S WOODLAWN
CHICAGO IL, 60615, US
Phone (773) 548-5026
Fax
Toxanomy
Taxonomy Code 103TC0700X
License State Illinois
License Number 071002095
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According to our database, Dr. Mary Ellen Moore PH D NPI is 1487735940, taxonomy code is 103TC0700X and license number is 071002095, license state is located at Illinois. Mary Ellen Moore PH D physically located at 5536 S Everett Ave, Chicago IL, 60637. NPI Number Mary Ellen Moore PH D has the Individual type.

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1487735940 NPI number is provided on an as is basis without warranty of any kind. 1487735940 is maintained by the National Plan & Provider Enumeration System. The contents of Mary Ellen Moore PH D are for informational purposes only.