Provider Demographics
NPI:1871814012
Name:MOORE, JAMEEKA DIONNDRA (PSYD)
Entity type:Individual
Prefix:
First Name:JAMEEKA
Middle Name:DIONNDRA
Last Name:MOORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 W NORTH AVE
Mailing Address - Street 2:306
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1634
Mailing Address - Country:US
Mailing Address - Phone:708-681-9214
Mailing Address - Fax:708-681-9280
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:306
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-681-9214
Practice Address - Fax:708-681-9280
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008336103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical