Provider Demographics
NPI:1083875413
Name:BERNHARD, TIMOTHY SCOTT (LAC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:BERNHARD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NORTHPOINT DRIVE
Mailing Address - Street 2:APT #A3
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1192
Mailing Address - Country:US
Mailing Address - Phone:715-342-4223
Mailing Address - Fax:
Practice Address - Street 1:1100 NORTHPOINT DR
Practice Address - Street 2:APT #A3
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1192
Practice Address - Country:US
Practice Address - Phone:715-342-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI109055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist