Individual
JENSEN M MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
1341 MARKET AVE N, CANTON, OH 44714-2605
(330) 453-8252
(330) 452-4655
Mailing address
625 CLEVELAND AVE NW, CANTON, OH 44702-1805
(330) 453-8252
(330) 453-6716
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I.2102686
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0273660
—
OH
Enumeration date
10/14/2016
Last updated
01/30/2023
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