Most Relevant Information
Provider Data
| NPI Number: | 1003651415 |
| Provider Name: | KENNON WHITING MOON |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/27/2024 |
| Last Updated: | 06/27/2024 |
Provider Practice Location
1925 N CLYBOURN AVE STE 300
CHICAGO
IL
606147395
Practice Location Phone/Fax
| Phone: | 7736978839 |
| Fax: |
Provider Mailing Location
321 S SANGAMON ST UNIT 401
CHICAGO
IL
606073623
Provider Mailing Phone/Fax
| Phone: | 7032174466 |
| Fax: |