Provider Demographics
NPI:1740700020
Name:MOEDER, ANTHONY (BCBA, COBA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MOEDER
Suffix:
Gender:M
Credentials:BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 WATER ST
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-1155
Mailing Address - Country:US
Mailing Address - Phone:513-432-4385
Mailing Address - Fax:
Practice Address - Street 1:90 COMPARK RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45459-4966
Practice Address - Country:US
Practice Address - Phone:937-688-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.352103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst