Healthcare Provider Details

I. General information

NPI: 1023927522
Provider Name (Legal Business Name): MR. AARON TYLER MOORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S24W36044 COUNTRYSIDE CT
DOUSMAN WI
53118-9688
US

IV. Provider business mailing address

S24W36044 COUNTRYSIDE CT
DOUSMAN WI
53118-9688
US

V. Phone/Fax

Practice location:
  • Phone: 608-886-0240
  • Fax:
Mailing address:
  • Phone: 608-886-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number135995-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: