Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180-001694 | IL |
NPI | 1003831413 |
---|---|
Provider Name | Ms. Linda K Moffatt |
First Address | Alton, IL 62002-4214 |
Second Address | Alton, IL 62002-4214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 06/01/2014 |