Provider Demographics
NPI:1649420498
Name:BEYER, TODD MICHAEL (HIS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:BEYER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S CENTRAL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-4140
Mailing Address - Country:US
Mailing Address - Phone:715-384-4700
Mailing Address - Fax:
Practice Address - Street 1:601 S CENTRAL AVE STE 300
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4140
Practice Address - Country:US
Practice Address - Phone:715-384-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1175-060237700000X
MN2660237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42835100Medicaid