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General NPI Number Information
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NPI Number | 1588068837
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Entity Type | Organization
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Legal Business Name | MOELLER, MYERS & ASSOCIATES, PC
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 302 E 5TH ST
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City | STERLING
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State | IL
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Zip | 61081-3755
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Country | US
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Telephone | 815-626-8760
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Fax | 815-626-8066
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Provider Business Mailing Address
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Address Line | 302 E 5TH ST
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City | STERLING
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State | IL
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Zip | 61081-3755
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Country | US
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Telephone | 815-626-8760
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Fax | 815-626-8066
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Authorized Official
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Title or Position | PRESIDENT
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Name | NATALIE MOELLER
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Credential | LCSW
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Telephone | 815-626-8760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.007644
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License Number State | IL
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