Provider Demographics
NPI:1710580501
Name:MOQUIN, MEGAN MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:MOQUIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 WELLNESS DR
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 W SAGINAW RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:MI
Practice Address - Zip Code:48657-9206
Practice Address - Country:US
Practice Address - Phone:989-687-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099963104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker