Shannon Lynn Moose, ATC, ROT, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096004184 Issued in IL

Practice address

255 Red Gate Rd
St Charles, IL 60175-6396

Phone

(224) 805-1199

NPI assigned

Oct 23, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1114748928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 CHIPPEWA DR",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605631387",
            "telephone_number": "224-805-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 RED GATE RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601756396",
            "telephone_number": "224-805-1199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOSE",
        "first_name": "SHANNON",
        "middle_name": "LYNN",
        "credential": "ATC, ROT, LAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-23",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096004184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Mols
• Matthew Jacob Mols
• Richard Monis, A.T.C.
• Joseph Brent Montgomery, LPN
• Kari Moore, MS, CCC-SLP
• Araceli Morales
• Jocelyn Moreno
• Robert Bruce Morgan, CRNA
• Stephanie J. Morris
• Patrick J Morrison, LCSW

• Athletic Trainer in St Charles, IL
• Providers in St Charles, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.