Individual
JACQUE D MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FLP
Contact information
Practice address
2310 RABY RD, EAST LANSING, MI 48823-7761
(235) 176-7697
Mailing address
PO BOX 10, MASON, MI 48854-0010
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301005067
MI
Other
Enumeration date
04/24/2006
Last updated
01/29/2020
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