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General NPI Number Information
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NPI Number | 1891991360
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Entity Type | Individual
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Provider Name | ELIZABETH FETTIG MSW
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Gender | Female
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 50 PRAIRIE AVE
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City | PRAIRIE DU SAC
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State | WI
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Zip | 53578-1541
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Country | US
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Telephone | 608-643-3147
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Fax | 608-643-3178
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Provider Business Mailing Address
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Address Line | 25 KESSEL CT STE 105
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City | MADISON
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State | WI
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Zip | 53711-6227
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9205-123
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License Number State | WI
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