Individual
MICHAEL J MOLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
900 6TH ST N, 102, HUDSON, WI 54016-7171
(715) 386-0856
(715) 386-0948
Mailing address
900 6TH ST N, 102, HUDSON, WI 54016-7171
(715) 386-0856
(715) 386-0948
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
2320
WI
103TC0700X
Clinical Psychologist
Primary
2320
WI
103TC2200X
Clinical Child & Adolescent Psychologist
2320
WI
103TF0000X
Family Psychologist
2320
WI
103TF0200X
Forensic Psychologist
2320
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01413
GROUP HEALTH
WI
01
—
01413
COMPCARE
—
01
—
036J4MO
BCBS MN PRO FEE
MN
01
—
115830
UCARE
—
01
—
1202109 16675
MAGELLEN
—
01
—
20558-03
BEHAVIOR HEALTH PROVIDERS
—
01
—
2172193
COMPSYCH
WI
01
—
39739300
WISCONSIN MEDICAL ASSISTANCE
WI
05
—
39739300
—
WI
01
—
431R2MO
BCBS
MN
01
—
439K4MO
BCBS
MN
01
—
61-74465
MEDICA / UBH
MN
01
—
61-74465
UBH
WI
05
—
880824400
—
MN
01
—
HP20346
HEALTHPARTNERS
MN
01
—
NA9031027526
PREFERRED ONE
MN
01
—
SSN
HEALTHNET / TRICARE
—
01
—
SSN001
ANTHEM BLUE CROSS OF WI
WI
Enumeration date
10/24/2006
Last updated
09/28/2010
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