Provider Demographics
NPI:1144624511
Name:PAAVOLA, TODD
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:PAAVOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7457 PINE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-8408
Mailing Address - Country:US
Mailing Address - Phone:715-505-6900
Mailing Address - Fax:
Practice Address - Street 1:7457 PINE RIDGE CT
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-8408
Practice Address - Country:US
Practice Address - Phone:715-505-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3001013649103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool