Lynn Marie Fagen Moore

NPI #1245519388 in Chisago City, Minnesota

Provider Information

NPI Number: 1245519388
Entity Type: Individual
Name: Lynn Marie Fagen Moore
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor - Addiction (Substance Use Disorder)
Enumeration Date: Aug 8, 2011
Last Updated: Aug 8, 2011

Practice Location

Address: 11720 256TH ST
City: Chisago City
State: Minnesota
ZIP Code: 55013-9752
Phone: (651) 257-4159

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X	Primary

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