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General NPI Number Information
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NPI Number | 1811038656
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Entity Type | Individual
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Provider Name | JOSEPH LOUIS BODO JR. LPC,CSAC,ICS
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 171 CHESTNUT ST
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City | PHILLIPS
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State | WI
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Zip | 54555-1313
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Country | US
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Telephone | 715-339-3048
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Fax |
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Provider Business Mailing Address
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Address Line | N7368 UNIVERSAL DR
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City | WINTER
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State | WI
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Zip | 54896-7635
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Country | US
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Telephone | 715-266-2400
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3232-125
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License Number State | WI
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