Healthcare Provider Details

I. General information

NPI: 1588068837
Provider Name (Legal Business Name): MOELLER, MYERS & ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E 5TH ST
STERLING IL
61081-3755
US

IV. Provider business mailing address

302 E 5TH ST
STERLING IL
61081-3755
US

V. Phone/Fax

Practice location:
  • Phone: 815-626-8760
  • Fax: 815-626-8066
Mailing address:
  • Phone: 815-626-8760
  • Fax: 815-626-8066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.007644
License Number StateIL

VIII. Authorized Official

Name: NATALIE MOELLER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 815-626-8760