MEDICARE: REBECCA MOORE SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146009655	IL

General Provider Information

NPI Number	:	1659513497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MOORE SLP

Provider Business Mailing Address
First Line	:	7358 N LINCOLN AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-1710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7358 N LINCOLN AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-1710
Country	:	US
Telephone Number	:	708-326-1550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	05/19/2022

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Directions to “ REBECCA MOORE SLP” Practice Location

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