Healthcare Provider Details

I. General information

NPI: 1538285044
Provider Name (Legal Business Name): KRISTIN MOORHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W LAKE COOK RD STE 102
BUFFALO GROVE IL
60089-1944
US

IV. Provider business mailing address

1110 W LAKE COOK RD STE 152
BUFFALO GROVE IL
60089-1997
US

V. Phone/Fax

Practice location:
  • Phone: 847-312-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.014935
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.007868
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146007868
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: