TIMOTHY JAMES MODER

SUPERIOR, WI
NPI1437332319
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WI  14242-130)
Enumeration Date2007-12-13
Last Update Date2007-12-13
Business Address
-- TIMOTHY JAMES MODER SAC-IT
1507 TOWER AVE # 307
SUPERIOR, WI 54880-2532
Phone number: 715-392-9300
Mailing Address
-- TIMOTHY JAMES MODER SAC-IT
1115 LINCOLN ST
SUPERIOR, WI 54880-6730
Phone number: 218-940-3518
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