Healthcare Provider Details

I. General information

NPI: 1770284929
Provider Name (Legal Business Name): ANDREA MARTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N MIDVALE BLVD STE 202
MADISON WI
53705-3265
US

IV. Provider business mailing address

725 W LINCOLN ST APT 2
WAUPUN WI
53963-1768
US

V. Phone/Fax

Practice location:
  • Phone: 608-238-9991
  • Fax:
Mailing address:
  • Phone: 920-319-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: