Individual
MR. ROBERT E MCMANIMON MOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS, ADC-T
Contact information
Practice address
131 HARRIET ST, WINONA, MN 55987-3177
(507) 454-2839
(507) 454-5864
Mailing address
131 HARRIET ST, WINONA, MN 55987-3177
(507) 454-2839
(507) 454-5864
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ADC-T
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39344000
—
WI
Enumeration date
06/08/2006
Last updated
10/05/2009
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