Individual
BECKY L FAWLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC
Contact information
Practice address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-3700
(920) 720-3806
Mailing address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-2300
(920) 720-3719
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16466
WI
Other
Enumeration date
10/16/2013
Last updated
07/28/2021
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