Provider Demographics
NPI:1790985000
Name:FEASTER, DAN G (LCSW MSW)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:G
Last Name:FEASTER
Suffix:
Gender:M
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 MONONA DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3556
Mailing Address - Country:US
Mailing Address - Phone:608-663-0763
Mailing Address - Fax:608-663-0765
Practice Address - Street 1:5900 MONONA DR STE 100
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3556
Practice Address - Country:US
Practice Address - Phone:608-663-0763
Practice Address - Fax:608-663-0765
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2511-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962544353OtherNPI FOR SAMARITAN COUNSEL
WI39567300Medicaid
WI1962544353OtherNPI FOR SAMARITAN COUNSEL