MEDICARE: MS. ROSEMARY SUSAN MOYLAN MS, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	8242-125	WI

General Provider Information

NPI Number	:	1568138899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSEMARY SUSAN MOYLAN MS, LPC, NCC

Provider Business Mailing Address
First Line	:	2580 N 100TH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-1642
Country	:	US
Telephone Number	:	414-899-2586
Fax Number	:

Provider Business Practice Location Address
First Line	:	4655 N PORT WASHINGTON RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1004
Country	:	US
Telephone Number	:	414-247-9530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	03/03/2026

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