Healthcare Provider Details

I. General information

NPI: 1568382737
Provider Name (Legal Business Name): ALICIA KATHLEEN MOORE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 NEWPORT DR
NAPERVILLE IL
60565-4339
US

IV. Provider business mailing address

2635 NEWPORT DR
NAPERVILLE IL
60565-4339
US

V. Phone/Fax

Practice location:
  • Phone: 309-531-6504
  • Fax:
Mailing address:
  • Phone: 309-531-6504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number24201878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: