Provider Demographics
NPI:1417112780
Name:AUGUSTINE, FRANCES M (CSAC,ICS,IDP/AT)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:M
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:CSAC,ICS,IDP/AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W OLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-2142
Mailing Address - Country:US
Mailing Address - Phone:608-255-5922
Mailing Address - Fax:608-255-0340
Practice Address - Street 1:810 W OLIN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-2142
Practice Address - Country:US
Practice Address - Phone:608-255-5922
Practice Address - Fax:608-255-0340
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15510130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1417112780Medicaid