Ms Dorothy A Fonstad, MSE, LCSW, CADC 111 is a
Social Worker based in Appleton, Wisconsin. Ms Dorothy A Fonstad is licensed to practice in Wisconsin (license number 3182) and her current practice location is
711 N Lynndale Dr Ste 1a, Appleton, Wisconsin. She can be reached at her office (for appointments etc.) via phone at
(920) 560-4525.
NPI number for Ms Dorothy A Fonstad is 1639246382 and her current mailing address is 3521 N Morrison St, Appleton, Wisconsin. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1639246382.
Healthcare Provider's Profile
| Full Name | Ms Dorothy A Fonstad |
|---|
| Gender | Female |
|---|
| Speciality | Social Worker |
|---|
| Location | 711 N Lynndale Dr Ste 1a, Appleton, Wisconsin |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1639246382
- Provider Enumeration Date: 11/29/2006
- Last Update Date: 02/21/2018
Medical Identifiers
Medical identifiers for Ms Dorothy A Fonstad such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1639246382 | NPI | - | NPPES |
| 39787600 | Medicaid | WI | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1554 (Wisconsin) | Secondary |
| 104100000X | Social Worker | 3182 (Wisconsin) | Primary |
| 101Y00000X | Counselor | 3182-123 (Wisconsin) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Dorothy A Fonstad is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ms Dorothy A Fonstad, MSE, LCSW, CADC 111
3521 N Morrison St,
Appleton, WI 54911-1251
Ph: (715) 214-3679 | Ms Dorothy A Fonstad, MSE, LCSW, CADC 111
711 N Lynndale Dr Ste 1a,
Appleton, WI 54914-3078
Ph: (920) 560-4525 |
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