Individual
MS. DOROTHY A FONSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSE, LCSW, CADC 111
Contact information
Practice address
711 N LYNNDALE DR STE 1A, APPLETON, WI 54914-3078
(920) 560-4525
(920) 560-6618
Mailing address
3521 N MORRISON ST, APPLETON, WI 54911-1251
(715) 214-3679
(920) 560-6618
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
3182-123
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
1554
WI
104100000X
Social Worker
Primary
3182
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39787600
—
WI
Enumeration date
11/29/2006
Last updated
02/21/2018
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