Fonstad, Dorothy A

Fonstad, Dorothy A is an individual health care provider with primary practice located at 711 N Lynndale Dr Ste 1A , Appleton WI 54914-3078. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Counselor. Behavioral Health & Social Service Providers / Social Worker is her primary health care specialty. Fonstad, Dorothy A can be contacted via phone (920) 560-4525.

Contact Information

Primary practice address
711 N Lynndale Dr Ste 1A Appleton WI 54914-3078
Phone: (920) 560-4525
Fax: (920) 560-6618
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 1554 Wisconsin
Behavioral Health & Social Service Providers / Social Worker 104100000X 3182 Wisconsin
Behavioral Health & Social Service Providers / Counselor 101Y00000X 3182-123 Wisconsin

Profile Details

NPI number 1639246382
LBN Legal business name Fonstad, Dorothy A
Credentials MSE, LCSW, CADC 111
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 29th, 2006
Last updated Feb 21st, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639246382 NPPES
Wisconsin MEDICAID 39787600

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