Individual
MS. KATHLEEN M MOSES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS MFT LCSW
Contact information
Practice address
808 MAIN ST E, MENOMONIE, WI 54751-2735
(715) 232-1116
(715) 232-5987
Mailing address
N6602 470TH ST, MENOMONIE, WI 54751-1280
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1343-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19677
MMSI PROVIDER NUMBER
MN
05
—
39539900
—
WI
Enumeration date
07/21/2006
Last updated
07/09/2007
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