Provider Demographics
NPI:1841680659
Name:MOEN, JULIA KIMBERLY (MSW LICSW)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:KIMBERLY
Last Name:MOEN
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 MONTROSE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1134
Mailing Address - Country:US
Mailing Address - Phone:651-698-4252
Mailing Address - Fax:651-698-3376
Practice Address - Street 1:821 RAYMOND AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1503
Practice Address - Country:US
Practice Address - Phone:651-642-9318
Practice Address - Fax:651-642-1908
Is Sole Proprietor?:No
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN92481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical