Koller, Timothy John
Koller, Timothy John is an individual health care provider with primary practice located at 401 5Th St Ste 235, Wausau WI 54403-5470. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Koller, Timothy John can be contacted via phone (715) 849-3311.Contact Information
Primary practice address
401 5Th St Ste 235
Wausau WI 54403-5470
Phone: (715) 849-3311
Fax: (715) 849-8414
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 2649-125 | Wisconsin |
Profile Details
| NPI number | 1407918998 |
|---|---|
| LBN Legal business name | Koller, Timothy John |
| Credentials | MS, LPC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 14th, 2006 |
| Last updated | Nov 11th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1407918998 | NPPES |
| Wisconsin | MEDICAID | 39756000 |
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