MEDICARE: MRS. LINDSAY ANN FANELLI-HUETTL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	132975-121	WI
2	1041S0200X	School Social Worker	132975-121	WI
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1023825940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDSAY ANN FANELLI-HUETTL

Provider Business Mailing Address
First Line	:	700 W MILWAUKEE ST
Second Line	:
City	:	JEFFERSON
State	:	WI
Zip	:	53549-1436
Country	:	US
Telephone Number	:	920-675-1133
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 COMMANDER CT
Second Line	:
City	:	FORT ATKINSON
State	:	WI
Zip	:	53538-3158
Country	:	US
Telephone Number	:	608-436-6302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2024
Last Update Date	:	08/28/2025

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