Individual
MR. TIM EDWARD MOLDENHAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS-CCC-SLP
Contact information
Practice address
410 DEWEY ST, WISCONSIN RAPIDS, WI 54494-4715
(715) 424-8500
(715) 424-8502
Mailing address
PO BOX 8080, 410 DEWEY STREET, WISCONSIN RAPIDS, WI 54495-8080
(715) 424-8500
(715) 424-8502
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
607-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42714700
—
WI
Enumeration date
05/07/2007
Last updated
03/13/2013
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