Active NPI
Stephanie G Harris-Moore
- Speech-Language Pathologist
- Park Forest, IL
National Provider Identifier
1659939072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1874259
- Practice address
- 228 Kentucky St
Park Forest, IL 60466-1222 - Phone
- (708) 408-0861
- NPI assigned
- May 31, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 1874259 | IL | Primary |
Addresses
Primary practice location
228 Kentucky St
Park Forest, IL 60466-1222
Mailing address
228 Kentucky St
Park Forest, IL 60466-1222
Phone (708) 408-0861
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1874259 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1874259 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559260800000",
"number": "1659939072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "228 KENTUCKY ST",
"city": "PARK FOREST",
"state": "IL",
"postal_code": "604661222",
"telephone_number": "708-408-0861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "228 KENTUCKY ST",
"city": "PARK FOREST",
"state": "IL",
"postal_code": "604661222",
"telephone_number": "708-408-0861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS-MOORE",
"first_name": "STEPHANIE",
"middle_name": "G",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-31",
"last_updated": "2019-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "1874259",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1874259",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Park Forest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.