Healthcare Provider Details

I. General information

NPI: 1023928009
Provider Name (Legal Business Name): KAYLA MARIE MOATS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 DAVIS ST
EVANSTON IL
60201-3608
US

IV. Provider business mailing address

1453 MAPLE AVE UNIT 104
EVANSTON IL
60201-4841
US

V. Phone/Fax

Practice location:
  • Phone: 847-492-1778
  • Fax: 847-448-0586
Mailing address:
  • Phone: 847-492-1778
  • Fax: 478-448-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.130606
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: