Healthcare Provider Details

I. General information

NPI: 1144138645
Provider Name (Legal Business Name): ISAIAH MOORMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 MC DOWELL RD STE 305
NAPERVILLE IL
60563-6507
US

IV. Provider business mailing address

454 RAINTREE DR
OSWEGO IL
60543-7939
US

V. Phone/Fax

Practice location:
  • Phone: 630-689-1022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.033097
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: