Kerie Moore, LCSW
Individual provider Active NPI Clinical Social Worker · Vienna, IL
NPI 1013392596 · NPPES record last updated Jul 31, 2019
Key facts
- NPI
- 1013392596
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149021412 (IL)
- Practice address
- 406 E Vine St
Vienna, IL 62995-1612 - Phone
- (618) 658-3079
- NPI assigned
- Jul 24, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149021412 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arrowleaf | Past |
Accepting new patients | |
| Family Counseling Center | Past | Accepting new patients | |
| Arrowleaf | Mental Health | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149021412 | IL | Yes |
Addresses
Primary practice location
406 E Vine St
Vienna, IL 62995-1612
Mailing address
408 E Vine St
PO Box 1328
Vienna, IL 62995-1612
Phone (618) 658-2611
Other providers in Vienna, IL
- Raelyn Melton
- Tiffany Meyers
- Emily Middleton
- Elizabeth Miller
- Kacey Minton
- Eden Morrison
- Chelsea Muir
- Amber Mulkins
- N & R of Vienna, LLC
- Sarah Newman
All providers in Vienna, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.