Individual
JORDAN MOEHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
633 PRAIRIE PKWY, FOND DU LAC, WI 54935
(920) 539-5417
Mailing address
633 PRAIRIE PKWY, FOND DU LAC, WI 54935-2737
(920) 539-5417
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2141
WI
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2017
Last updated
08/07/2018
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