Individual provider Active NPI

Tera Marie Mae Rodriguez, IPHM

  • Case Manager/Care Coordinator
  • Kiel, WI
National Provider Identifier
1063356152
Registry record updated May 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
620 12TH St Lot 9C
Kiel, WI 53042-4830
Phone
(920) 571-7269
NPI assigned
Apr 17, 2026
Last updated
May 2, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X WI Primary
Community/Behavioral Health Agency 251S00000X NU
Peer Specialist 175T00000X WI
Health & Wellness Coach 171400000X NU
Behavior Technician 106S00000X RBT-24-377640 WI

Addresses

Primary practice location

620 12TH St Lot 9C
Kiel, WI 53042-4830

Mailing address

620 12TH St Lot 9C
Kiel, WI 53042-4830
Phone (920) 571-7269

Other identifiers 1

IdentifierTypeStateIssuer
100413504MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RBT-24-377640WIMDBehavior Technician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1776384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777680000000",
    "number": "1063356152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 12TH ST LOT 9C",
            "city": "KIEL",
            "state": "WI",
            "postal_code": "530424830",
            "telephone_number": "920-571-7269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 12TH ST LOT 9C",
            "city": "KIEL",
            "state": "WI",
            "postal_code": "530424830",
            "telephone_number": "920-571-7269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "TERA MARIE",
        "middle_name": "MAE",
        "name_prefix": "Mrs.",
        "credential": "IPHM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-04-17",
        "last_updated": "2026-05-02",
        "certification_date": "2026-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "WI",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "WI",
            "license": "RBT-24-377640",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100413504",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kiel, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.