Provider Demographics
NPI:1447218987
Name:FOGLESON, CAROL L (CSAC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:FOGLESON
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADCIII
Mailing Address - Street 1:220 E LA CROSSE ST
Mailing Address - Street 2:JUNEAU COUNTY HUMAN SERVICES
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-2101
Mailing Address - Country:US
Mailing Address - Phone:608-847-2400
Mailing Address - Fax:608-847-9599
Practice Address - Street 1:220 E LA CROSSE ST
Practice Address - Street 2:JUNEAU COUNTY HUMAN SERVICES
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-2101
Practice Address - Country:US
Practice Address - Phone:608-847-2400
Practice Address - Fax:608-847-9599
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1799132101YA0400X
WI1799101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39355300Medicaid