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General NPI Number Information
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NPI Number | 1770539827
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Entity Type | Individual
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Provider Name | THEODORE E MOLLERUD
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 2215 E CLAIREMONT AVE SUITE 2
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4772
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Country | US
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Telephone | 715-831-0289
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Fax | 715-831-4722
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Provider Business Mailing Address
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Address Line | 2215 E CLAIREMONT AVE SUITE 2
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4772
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Country | US
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Telephone | 715-831-0289
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Fax | 715-831-4722
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 30-156
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License Number State | WI
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