Provider Demographics
NPI:1851188056
Name:MOON, OUSIA (APSW)
Entity type:Individual
Prefix:
First Name:OUSIA
Middle Name:
Last Name:MOON
Suffix:
Gender:
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 S GREELEY ST STE 356
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2024
Mailing Address - Country:US
Mailing Address - Phone:414-644-0006
Mailing Address - Fax:
Practice Address - Street 1:2625 S GREELEY ST STE 356
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2024
Practice Address - Country:US
Practice Address - Phone:414-644-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI135291-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical