TIMOTHY JAMES MODER (NPI# 1437332319) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437332319 |
| Entity Type | Individual |
| Full Name | TIMOTHY JAMES MODER |
| Credential | SAC-IT |
| Practice Address |
1507 Tower Ave # 307 Superior WI 54880-2532 |
| Mailing Address |
1115 Lincoln St Superior WI 54880-6730 |
| Practice Telephone | 7153929300 |
| Practice Fax Number | 7153928041 |
| Mailing Telephone | 2189403518 |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2007-12-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
14242-130 | WI | Behavioral Health & Social Service Providers |
| Street Address |
1507 TOWER AVE # 307 |
| City | SUPERIOR |
| State | WI |
| Zip Code | 54880-2532 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376587279 | Richard Mathias Johnson | Dentist | 1507 Tower Ave, Rm 427, Superior, WI 54880 | 2006-06-15 |
| 1306144597 | Edward C Wipson | Counselor | 1507 Tower Ave, Suite 210, Superior, WI 54880-2532 | 2011-03-11 |
| 1114230968 | Twin Ports Dental | Dentist | 1507 Tower Ave, Room 427, Superior, WI 54880-2532 | 2010-07-22 |
| 1538472907 | Neil Olson | Dentist | 1507 Tower Ave, Room 427, Superior, WI 54880-2532 | 2010-07-14 |
| 1386970630 | Alisha Marie Bliss | Counselor | 1507 Tower Ave, Suite 307, Superior, WI 54880-2532 | 2009-10-21 |
| 1417113259 | Neal Burton O'shaughnessy Jr. | Dentist | 1507 Tower Ave, Suite 410, Superior, WI 54880-2532 | 2008-07-31 |
| 1063632552 | Arthur David Zehm | Dentist | 1507 Tower Ave, Ste 409, Superior, WI 54880 | 2007-04-26 |
| 1285859041 | Ridgewood Recovery, Inc. | Clinic/Center | 1507 Tower Ave, Suite 307, Superior, WI 54880-2532 | 2007-04-16 |
| 1417026485 | Ronald Keith Underdale | Dentist | 1507 Tower Ave, Suite 211, Superior, WI 54880-2554 | 2006-11-06 |
| 1194828269 | Brent T Johnson | Dentist | 1507 Tower Ave, Suite 202, Superior, WI 54880 | 2006-09-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104427194 | Alana Catherine Sullivan | Speech-Language Pathologist | 25 N 25th Street E, Superior, WI 54880 | 2020-11-05 |
| 1710524970 | Sean Wiberg Peterson | Specialist/Technologist | 1810 Catlin Ave, Room 1246, Superior, WI 54880 | 2019-12-06 |
| 1558858936 | Brent Adam Engstrom | Student in an Organized Health Care Education/Training Program | 1410 Nth 23rd Street, Superior, WI 54880 | 2018-04-20 |
| 1558769125 | David Kroll | Specialist | Balknap & Catlin Aves., Superior, WI 54880 | 2014-12-15 |
| 1154670321 | Superior Treatment Center, Inc | Community/Behavioral Health | 1507 Tower Ave Ste 307, Superior, WI 54880 | 2012-09-04 |
| 1548551658 | Dionne Jeannine Corcoran | Midwife | 916 Hammond Ave Ste 222, Superior, WI 54880 | 2011-04-22 |
| 1821235433 | Lauren Ashley Miller | Speech-Language Pathologist | 35 N. 28th Street, Superior, WI 54880 | 2009-01-20 |
| 1528261989 | Stacy Ann Kennelly | Physical Therapist | 1612 N 37th Street, Superior, WI 54880 | 2007-06-06 |
| 1760564942 | James Henry Dobis | Family Medicine | 3520 Tower Avenue, Twin Ports Va Outpatient Clinic, Superior, WI 54880 | 2006-10-19 |
| 1134214398 | Kevin M Mikel | Dentist | 3312 Tower Avenue, Superior, WI 54880 | 2006-10-04 |
| Find all providers in zip 54880 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518580182 | Michele Denise Perron | Counselor | 912 Baxter Ave, Superior, WI 54880-1735 | 2020-05-18 |
| 1265066500 | Masc LLC | Counselor | 491 Shaw Gulch Lane, Superior, MT 59872-0214 | 2020-02-25 |
| 1386160976 | Leann Joyce Anderson | Counselor | 304 4th Ave E, Superior, MT 59872 | 2017-08-16 |
| 1578090049 | Barbara Titus | Counselor | 1810 Belknap St, Superior, WI 54880-2595 | 2017-05-16 |
| 1346636115 | Debra Rybos | Counselor | 2120 John Ave, Superior, WI 54880-4923 | 2015-04-08 |
| 1083036305 | Stephanie Quick | Counselor | 405 Brooklyn St, Superior, MT 59872-9607 | 2014-01-07 |
| 1578823589 | Stewart Andrew Mccracken | Counselor | 491 Shaw Gulch Ln, Superior, MT 59872-0124 | 2012-05-23 |
| 1245558840 | Choices, Inc. | Counselor | 304 4th Ave. E, Superior, MT 59872-0622 | 2010-05-07 |
| 1770716771 | Rae Jean Bergner | Counselor | 1500 N 34th St Ste 200, Superior, WI 54880-4477 | 2009-08-25 |
| 1831371350 | Elizabeth B Byler | Counselor | 1531 Hughitt Ave, Superior, WI 54880-2855 | 2007-11-27 |
| Find all providers in SUPERIOR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.