Provider Demographics
NPI:1134398514
Name:MORAN, ANN (LPC, SAC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:LPC, SAC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, LADAC
Mailing Address - Street 1:651 21ST ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1251
Mailing Address - Country:US
Mailing Address - Phone:608-432-8980
Mailing Address - Fax:
Practice Address - Street 1:260 26TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-2203
Practice Address - Country:US
Practice Address - Phone:608-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16048-131101YA0400X
WI4810-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)