Healthcare Provider Details

I. General information

NPI: 1023939030
Provider Name (Legal Business Name): TRICIA MOONEY-FOGARTY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 THACKERAY RD
MADISON WI
53704-2366
US

IV. Provider business mailing address

1818 THACKERAY RD
MADISON WI
53704-2366
US

V. Phone/Fax

Practice location:
  • Phone: 262-498-9522
  • Fax:
Mailing address:
  • Phone: 262-498-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9550-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: