| Doctor Name: | MS. VIRGINIA ELLEN MOON |
| NPI Number: | 1780919506 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. |
| License Number: | |
| Business Practice Address: | 203 South 16th Court Wautoma, WI - 54982 |
| Business Phone Number: | 9207876710 |
| Business Fax Number: | |
| Mailing Address: | 203 South 16th Court, WAUTOMA |
| State: | WI |
| Postal Code: | 54982 |
| Phone Number: | 9207876710 |
| Fax Number: | |
| NPI Enumeration Date: | 10/13/2009 |
| NPI Last Update Date: | 10/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |