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NPI Code Detail

MEDICARE: MS. SHIRLEY L. MOORE

MEDICARE: MS. SHIRLEY L. MOORE
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
11041C0700XClinical Social Worker6801099162MI

General Provider Information

NPI Number : 1972930808
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHIRLEY L. MOORE
Provider Business Mailing Address
First Line : 625 HARRISON ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49007-3681
Country : US
Telephone Number : 269-323-1954
Fax Number : 269-276-0201
Provider Business Practice Location Address
First Line : 625 HARRISON ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49007-3681
Country : US
Telephone Number : 269-323-1954
Fax Number : 269-323-1954
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2013
Last Update Date : 03/31/2016

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