MR. JACK GEORGE RUDOLPH (NPI# 1487823308) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487823308 |
| Entity Type | Individual |
| Full Name | MR. JACK GEORGE RUDOLPH |
| Practice Address |
540 College Ave Medford WI 54451-2027 |
| Practice Telephone | 7157483332 |
| Practice Fax Number | 7157483342 |
| Mailing Telephone | 7157483332 |
| Mailing Fax Number | 7157483342 |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-03-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | 2651-125 | WI | Behavioral Health & Social Service Providers |
| Street Address |
540 COLLEGE AVE |
| City | MEDFORD |
| State | WI |
| Zip Code | 54451-2027 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538373022 | Taylor County | Counselor | 540 College Ave, Medford, WI 54451-2027 | 2007-05-10 |
| 1568645604 | Taylor County | Early Intervention Provider Agency | 540 College Ave, Medford, WI 54451-2027 | 2007-12-12 |
| 1801092374 | Taylor County | Community/Behavioral Health | 540 College Ave, Medford, WI 54451 | 2007-06-22 |
| 1710183280 | Taylor County | Case Management | 540 College Ave, Medford, WI 54451-2027 | 2007-06-22 |
| 1881809119 | Kelly J Schultz | Counselor | 540 College Ave, Medford, WI 54451-2027 | 2007-05-11 |
| 1740494228 | Anthony J Schmidt | Counselor | 540 College Ave, Medford, WI 54451-2027 | 2007-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710536321 | Bone & Joint Clinic S.c. | Durable Medical Equipment & Medical Supplies | 724 S. 8th St, Medford, WI 54451 | 2019-09-06 |
| 1215474671 | Heidi Marie Nernberger | Dental Hygienist | 124 S. Main Street, Medford, WI 54451 | 2017-01-24 |
| 1497152656 | Rachel E Nichols | Dental Hygienist | 124 South Main St, Medford, WI 54451 | 2014-12-03 |
| 1811305360 | Amanda Mosse | Social Worker | 10649 W Perkinstown Ave, Medford, WI 54451 | 2014-07-29 |
| 1891081113 | Debra Jeanne Zenner | Nurse Practitioner | 143 South Gibson St., Medford, WI 54451 | 2011-06-24 |
| 1033445036 | Greg George Schoofs II | Ophthalmology | N 4803 Wigwam Ave, Medford, WI 54451 | 2009-10-26 |
| 1558511295 | Aspirus Medford Hospital & Clinics, Inc. | Clinic/Center | 111 S Gibson St, Medford, WI 54451 | 2008-09-30 |
| 1013132430 | Aspirus Medford Hospital & Clinics, Inc. | Pharmacy | 139 S Gibson St, Medford, WI 54451 | 2007-04-13 |
| 1356566707 | Peter G Kiefer | Pharmacist | 139 South Gibson St, Medford, WI 54451 | 2007-04-13 |
| 1851426753 | Steven Todd Dietzman | Specialist/Technologist | 103 South Gibson Street, Medford, WI 54451 | 2007-02-22 |
| Find all providers in zip 54451 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922658830 | Michelle Anne Zona | Counselor | 100 George Hassett Dr, Medford, MA 02155 | 2019-09-13 |
| 1689223901 | Holly Hermes | Counselor | 48 Hawthorne St, Medford, OR 97504-7114 | 2019-09-09 |
| 1417473554 | Elysee H. Castor | Counselor | 5 High St., Suite 101, Medford, MA 02155 | 2017-08-21 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1336597541 | Joanna Lea Ballard | Counselor | 1175 E Main St Ste C1, Medford, OR 97504-7457 | 2016-05-27 |
| 1386018240 | Sarie R Scully | Counselor | 26 Horseshoe Curv, Medford, NJ 08055-9751 | 2015-11-16 |
| 1992103451 | Sean Alexander Mickelson | Counselor | 358 S Oakdale Ave, Medford, OR 97501-3131 | 2014-12-16 |
| 1134472863 | Lynette J Milligan | Counselor | 142 N Ivy St Ste 2, Medford, OR 97501-2758 | 2012-10-18 |
| 1154687689 | Phylicia Mcdonald | Counselor | 176 Jerome St, Medford, MA 02155-3535 | 2012-04-10 |
| 1215205901 | Shelly Hohl | Counselor | 1000 E Main St Bldg B, Medford, OR 97504-7449 | 2011-12-08 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.