Healthcare Provider Details

I. General information

NPI: 1043476849
Provider Name (Legal Business Name): KAREN D MOORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN DIANE BALLREICH

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TANGLEWOOD DR
DEFIANCE OH
43512-3637
US

IV. Provider business mailing address

1901 TANGLEWOOD DR
DEFIANCE OH
43512-3637
US

V. Phone/Fax

Practice location:
  • Phone: 419-630-3805
  • Fax:
Mailing address:
  • Phone: 419-630-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3330
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: