Provider Demographics
NPI:1730428525
Name:MOORE, TAYLOR LEYH (MSW)
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:LEYH
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 N SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2520
Mailing Address - Country:US
Mailing Address - Phone:630-405-8394
Mailing Address - Fax:
Practice Address - Street 1:2823 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7403
Practice Address - Country:US
Practice Address - Phone:773-340-2517
Practice Address - Fax:773-688-1729
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MN245551041C0700X
IL149.0215751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)