Provider Demographics
NPI:1518477660
Name:MARCHILLO, AUDREY ELAINE (SACIT)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:ELAINE
Last Name:MARCHILLO
Suffix:
Gender:F
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3447 BEE LN
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1901
Mailing Address - Country:US
Mailing Address - Phone:608-361-7200
Mailing Address - Fax:608-361-7201
Practice Address - Street 1:3447 BEE LN
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1901
Practice Address - Country:US
Practice Address - Phone:608-361-7200
Practice Address - Fax:608-361-7201
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17808-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI17808-130OtherSACIT