Search › Minnesota › 101YA0400X
Derryck Moore, LADC
NPI 1336381599 · on the registry since 2009 · sole proprietor
Practice
- Address
- 12400 25th Ave N
Plymouth, MN 55441 - Phone
- (612) 220-8645
- Fax
- (952) 405-8090
Registry record
- Primary taxonomy
- 101YA0400X
101YA0400X
- Licence states on file
- MN
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2009-04-01
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Minnesota