Healthcare Provider Details

I. General information

NPI: 1124709894
Provider Name (Legal Business Name): ISABEL MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ISABEL CRESPO

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737 W WASHINGTON ST STE 3115
WEST ALLIS WI
53214-5651
US

IV. Provider business mailing address

6737 W WASHINGTON ST STE 3115
WEST ALLIS WI
53214-5651
US

V. Phone/Fax

Practice location:
  • Phone: 414-256-0077
  • Fax: 414-256-0090
Mailing address:
  • Phone: 414-256-0077
  • Fax: 414-256-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1126-140
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: