Provider Demographics
NPI:1609852722
Name:MOYER, KELLY J (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:J
Last Name:MOYER
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:CONNERTON-MOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:1152 S GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1941
Mailing Address - Country:US
Mailing Address - Phone:708-445-9917
Mailing Address - Fax:
Practice Address - Street 1:2160 SOUTH FIRST AVE
Practice Address - Street 2:RM.1024/BUILD 103 - OB/GYN, LUMC
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-8167
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS