Provider Demographics
NPI:1528115805
Name:MORAN, SUZANNE (LPC,CADCIII)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:LPC,CADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6417 ODANA RD.
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1128
Mailing Address - Country:US
Mailing Address - Phone:608-442-1637
Mailing Address - Fax:608-442-1887
Practice Address - Street 1:6417 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1128
Practice Address - Country:US
Practice Address - Phone:608-442-1637
Practice Address - Fax:608-442-1887
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1890101YA0400X
WI3357-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)