Healthcare Provider Details

I. General information

NPI: 1366362055
Provider Name (Legal Business Name): FVATP INTEGRATED SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 N SYSTEMS DR
APPLETON WI
54914-6402
US

IV. Provider business mailing address

4 N SYSTEMS DR
APPLETON WI
54914-6402
US

V. Phone/Fax

Practice location:
  • Phone: 920-205-0475
  • Fax:
Mailing address:
  • Phone: 920-205-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: STACI FERG
Title or Position: OWNER
Credential: BCBA
Phone: 920-205-0475