MEDICARE: OUSIA MOON APSW

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	1041C0700X	Clinical Social Worker	135291-121	WI

General Provider Information

NPI Number	:	1851188056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OUSIA MOON APSW

Provider Business Mailing Address
First Line	:	2625 S GREELEY ST STE 356
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2024
Country	:	US
Telephone Number	:	414-644-0006
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 S GREELEY ST STE 356
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2024
Country	:	US
Telephone Number	:	414-644-0006
Fax Number	:

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

Provider Enumeration Date	:	04/22/2025
Last Update Date	:	04/22/2025

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Directions to “ OUSIA MOON APSW” Practice Location

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