Provider Demographics
NPI:1023825940
Name:FANELLI-HUETTL, LINDSAY ANN
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:ANN
Last Name:FANELLI-HUETTL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-1436
Mailing Address - Country:US
Mailing Address - Phone:920-675-1133
Mailing Address - Fax:
Practice Address - Street 1:700 W MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-1436
Practice Address - Country:US
Practice Address - Phone:920-675-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132975-1211041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool