Provider Demographics
NPI:1831962596
Name:MORAN, AIMEE LYNN (LGSW)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:LYNN
Last Name:MORAN
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-2519
Mailing Address - Country:US
Mailing Address - Phone:218-591-2190
Mailing Address - Fax:
Practice Address - Street 1:310 4TH AVE SE STE 5010
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1708
Practice Address - Country:US
Practice Address - Phone:612-284-3220
Practice Address - Fax:612-200-0339
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN312501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical