Joseph Louis Bodo Jr., LPC,CSAC,ICS
Individual provider Active NPI Counselor · Phillips, WI
NPI 1811038656 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1811038656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 3232-125 (WI)
- Practice address
- 171 Chestnut St
Phillips, WI 54555-1313 - Phone
- (715) 339-3048
- NPI assigned
- Feb 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3232-125 | WI | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 3232-125 | WI | Yes |
Addresses
Primary practice location
171 Chestnut St
Phillips, WI 54555-1313
Mailing address
N7368 Universal Dr
Winter, WI 54896-7635
Phone (715) 266-2400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39380000 | Medicaid | WI |
Other providers in Phillips, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.