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General NPI Number Information
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NPI Number | 1295447597
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Entity Type | Individual
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Provider Name | HANNAH MOORE
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Gender | Female
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 4007 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60613-6074
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Country | US
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Telephone | 773-304-8723
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Fax |
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Provider Business Mailing Address
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Address Line | 4007 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60613-6074
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Country | US
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Telephone | 717-371-1166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.017809
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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