Active NPI
Lisa Marie Moon
- Addiction (Substance Use Disorder) Counselor
- Madison, WI
National Provider Identifier
1699340075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 19349-130
- Practice address
- 5005 University Ave
Madison, WI 53705-5439 - Phone
- (608) 233-2100
- Fax
- (608) 233-2021
- NPI assigned
- May 26, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 19349-130 | WI | Primary |
Addresses
Primary practice location
5005 University Ave
Madison, WI 53705-5439
Mailing address
1021 N Mulford Rd
Rockford, IL 61107-3874
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19349-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621987200000",
"number": "1699340075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1021 N MULFORD RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611073874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5005 UNIVERSITY AVE",
"city": "MADISON",
"state": "WI",
"postal_code": "537055439",
"telephone_number": "608-233-2100",
"fax_number": "608-233-2021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "LISA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-26",
"last_updated": "2021-05-26",
"certification_date": "2021-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "19349-130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.