Individual
DR. SALLY RUTH MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
430 OAK GROVE ST, 302, MINNEAPOLIS, MN 55403-3253
(612) 871-4336
(612) 929-2331
Mailing address
430 OAK GROVE ST, 302, MINNEAPOLIS, MN 55403-3253
(612) 871-4336
(612) 929-2331
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LP1891
MN
106H00000X
Marriage & Family Therapist
809
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1016212
CIGNA, PREFERREDONE
MN
01
—
61-69529
MEDICA
MN
05
—
621853900
—
MN
01
—
67Q05MO
BCBSMN
MN
Enumeration date
11/01/2006
Last updated
11/08/2007
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