Active NPI
Tim Edward Moldenhauer, MS-CCC-SLP
- Speech-Language Pathologist
- Wisconsin Rapids, WI
National Provider Identifier
1457564403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 607-154
- Practice address
- 410 Dewey St
Wisconsin Rapids, WI 54494-4715 - Phone
- (715) 424-8500
- Fax
- (715) 424-8502
- NPI assigned
- May 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 607-154 | WI | Primary |
Addresses
Primary practice location
410 Dewey St
Wisconsin Rapids, WI 54494-4715
Mailing address
PO Box 8080
410 Dewey Street
Wisconsin Rapids, WI 54495-8080
Phone (715) 424-8500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42714700 | Medicaid | WI |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 607-154 | WI | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aspirus Wausau Hospital, Inc. | Past | Accepting new patients | |
| Riverview Hospital Association | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Nephrology Physician
- Wausau, WI
- NPI 1629179908
-
- Skilled Nursing Facility
- Wisconsin Rapids, WI
- NPI 1114944543
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363132800000",
"number": "1457564403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8080",
"address_2": "410 DEWEY STREET",
"city": "WISCONSIN RAPIDS",
"state": "WI",
"postal_code": "544958080",
"telephone_number": "715-424-8500",
"fax_number": "715-424-8502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 DEWEY ST",
"city": "WISCONSIN RAPIDS",
"state": "WI",
"postal_code": "544944715",
"telephone_number": "715-424-8500",
"fax_number": "715-424-8502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLDENHAUER",
"first_name": "TIM",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "MS-CCC-SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-07",
"last_updated": "2013-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "607-154",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42714700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wisconsin Rapids, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.