Healthcare Provider Details

I. General information

NPI: 1942113568
Provider Name (Legal Business Name): FAITH MOONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E MAIN ST
WEST FRANKFORT IL
62896-2406
US

IV. Provider business mailing address

208 E MAIN ST
WEST FRANKFORT IL
62896-2406
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-6944
  • Fax:
Mailing address:
  • Phone: 618-242-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.032095
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: