Provider Demographics
NPI:1134757461
Name:MOSS, AUNDREA (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:AUNDREA
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9725 WOODS DR UNIT 1111
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4454
Mailing Address - Country:US
Mailing Address - Phone:847-420-3713
Mailing Address - Fax:
Practice Address - Street 1:9725 WOODS DR UNIT 1111
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4454
Practice Address - Country:US
Practice Address - Phone:847-420-3713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490220821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical