Provider Demographics
NPI:1386417244
Name:MORAN, ALEXANDRIA HOPE
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:HOPE
Last Name:MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4224
Mailing Address - Country:US
Mailing Address - Phone:262-758-9441
Mailing Address - Fax:
Practice Address - Street 1:750 VETERANS PKWY UNIT 100
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4950
Practice Address - Country:US
Practice Address - Phone:262-248-7942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1326061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical