Healthcare Provider Details

I. General information

NPI: 1568520724
Provider Name (Legal Business Name): LINDA GORSKE MORAN MS LC PC CT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 BURLINGTON AVE
WESTERN SPRINGS IL
60558
US

IV. Provider business mailing address

1023 BURLINGTON AVE
WESTERN SPRINGS IL
60558
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-5280
  • Fax: 708-354-0867
Mailing address:
  • Phone: 708-354-5280
  • Fax: 708-354-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: