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Individual

MS. LISA LYNELLE MOORE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSW, LICSW, PHD

Contact information

Practice address
2637 27TH AVE S STE 231, MINNEAPOLIS, MN 55406-3196
(503) 528-4033
Mailing address
1304 LIBERTY CT, NORTHFIELD, MN 55057-2915
(503) 528-4033

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
115630
MA

Other

Enumeration date
03/05/2010
Last updated
05/04/2018
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