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General NPI Number Information
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NPI Number | 1457037210
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Entity Type | Individual
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Provider Name | KATHRYN O MOORE
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Gender | Female
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1028 WALNUT ST
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City | YANKTON
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State | SD
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Zip | 57078-2910
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Country | US
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Telephone | 605-665-4606
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 W NATIONAL AVE FL 3
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City | MILWAUKEE
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State | WI
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Zip | 53295-0001
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Country | US
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Telephone | 414-384-2000
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5353-57
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License Number State | WI
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