Provider Demographics
NPI:1861033318
Name:MORAN, PAT A (LADC)
Entity Type:Individual
Prefix:
First Name:PAT
Middle Name:A
Last Name:MORAN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:48548 POWWOW HWY
Mailing Address - Street 2:
Mailing Address - City:PONSFORD
Mailing Address - State:MN
Mailing Address - Zip Code:56575
Mailing Address - Country:US
Mailing Address - Phone:218-255-3555
Mailing Address - Fax:218-573-2027
Practice Address - Street 1:48548 POWWOW HWY
Practice Address - Street 2:
Practice Address - City:PONSFORD
Practice Address - State:MN
Practice Address - Zip Code:56575-5657
Practice Address - Country:US
Practice Address - Phone:218-255-3555
Practice Address - Fax:218-573-2027
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MN300262101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)