Healthcare Provider Details

I. General information

NPI: 1790696409
Provider Name (Legal Business Name): HALLIE Y FECTEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 MONROE ST
MADISON WI
53711-2051
US

IV. Provider business mailing address

7716 INDIGO DR
DEFOREST WI
53532-2408
US

V. Phone/Fax

Practice location:
  • Phone: 608-262-1866
  • Fax:
Mailing address:
  • Phone: 920-328-4755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: