Provider Demographics
NPI:1730259482
Name:MOYER, DALE M (PHD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:M
Last Name:MOYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S DEARBORN ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1819
Mailing Address - Country:US
Mailing Address - Phone:312-986-8984
Mailing Address - Fax:
Practice Address - Street 1:720 S DEARBORN ST
Practice Address - Street 2:SUITE 404
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1819
Practice Address - Country:US
Practice Address - Phone:312-986-8984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL574670Medicare ID - Type Unspecified