Individual
LISA MARIE MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5005 UNIVERSITY AVE, MADISON, WI 53705-5439
(608) 233-2100
(608) 233-2021
Mailing address
1021 N MULFORD RD, ROCKFORD, IL 61107-3874
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19349-130
WI
Other
Enumeration date
05/26/2021
Last updated
05/26/2021
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