Individual
JEANETTE LUCILLE MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
211 AVENUE M W, FORT DODGE, IA 50501-5789
(515) 575-7261
Mailing address
211 AVENUE M W, FORT DODGE, IA 50501-5789
(515) 575-7261
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
23105
IA
Other
Enumeration date
02/21/2023
Last updated
02/21/2023
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