Individual
TIMOTHY JAMES MODER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Contact information
Practice address
1507 TOWER AVE, # 307, SUPERIOR, WI 54880-2532
(715) 392-9300
(715) 392-8041
Mailing address
1115 LINCOLN ST, SUPERIOR, WI 54880-6730
(218) 940-3518
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14242-130
WI
Other
Enumeration date
12/13/2007
Last updated
12/13/2007
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