Individual
MR. JOHN PATRICK MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
ONE VETERANS DRIVE, VA MEDICAL CENTER (116A2/3), MINNEAPOLIS, MN 55417
(612) 467-4783
(612) 467-5309
Mailing address
8385 113TH ST S, COTTAGE GROVE, MN 55016-4520
(651) 458-8647
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13225
MN
Other
Enumeration date
08/10/2006
Last updated
07/08/2007
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