Healthcare Provider Details

I. General information

NPI: 1245809656
Provider Name (Legal Business Name): BRIDGET MICHELE MORAN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W WASHINGTON ST
MARQUETTE MI
49855-4014
US

IV. Provider business mailing address

1025 W WASHINGTON ST STE B
MARQUETTE MI
49855-4031
US

V. Phone/Fax

Practice location:
  • Phone: 906-262-0071
  • Fax:
Mailing address:
  • Phone: 906-262-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851109698
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: