Jodi L. Opper

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5689-125 Issued in WI

Practice address

W3275 Wolf River Road
Menominee Tribal Clinic
Keshena, WI 54135-0970

Phone

(715) 799-3361

Fax

(715) 799-3099

NPI assigned

Jan 22, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jodi L. Fossum Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Menominee Indian Tribe of Wisconsin

  • Family Medicine Physician
  • Keshena, WI
  • NPI 1568404721
  NPD (past)

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

{
    "created_epoch": "1358812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493164800000",
    "number": "1962740258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970",
            "address_2": "MENOMINEE TRIBAL CLINIC",
            "city": "KESHENA",
            "state": "WI",
            "postal_code": "541350970",
            "telephone_number": "715-799-3361",
            "fax_number": "715-799-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W3275 WOLF RIVER ROAD",
            "address_2": "MENOMINEE TRIBAL CLINIC",
            "city": "KESHENA",
            "state": "WI",
            "postal_code": "541350970",
            "telephone_number": "715-799-3361",
            "fax_number": "715-799-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OPPER",
        "first_name": "JODI",
        "middle_name": "L.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-22",
        "last_updated": "2017-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "1627-226",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5689-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JODI",
            "last_name": "FOSSUM",
            "middle_name": "L.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Menominee Indian Tribe of Wisconsin
• Jacqueline Susan Moe, APNP
• Mary Nahwahquaw, CSAC
• Heather Marie Nennig, MD
• Michael J O'Neill, M.D.
• Estelle Ostgard, MD
• Elizabeth A Radtke-Petri, N.P.
• Carol Lynn Marie Reichardt, MSW, LCSW
• Leah Rouse
• Amy J. Slagle, M.D.

• Professional Counselor in Keshena, WI
• Providers in Keshena, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2017; 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.