Individual
MISTY FAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
819 ASH ST, SPOONER, WI 54801-1201
(715) 939-1248
(715) 939-1248
Mailing address
PO BOX 93, SPOONER, WI 54801-0093
(715) 939-1248
(715) 939-1248
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18954-130
WI
Other
Enumeration date
07/29/2020
Last updated
07/29/2020
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