Healthcare Provider Details

I. General information

NPI: 1134187750
Provider Name (Legal Business Name): ANNTIONETTE M FELLER CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 HIGHLAND AVE
EAU CLAIRE WI
54701-4455
US

IV. Provider business mailing address

2005 HIGHLAND AVE
EAU CLAIRE WI
54701-4455
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-5454
  • Fax: 715-832-2991
Mailing address:
  • Phone: 715-832-5454
  • Fax: 715-832-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNA
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13209
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: