MEDICARE: KAYLA JOANNE FAUSTI LPC, SAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	10993-125	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10993	OTHER	WI	WISCONSIN LICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1316545452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA JOANNE FAUSTI LPC, SAC

Provider Business Mailing Address
First Line	:	1160 ENGEL DR APT 102
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166-3756
Country	:	US
Telephone Number	:	715-701-3552
Fax Number	:

Provider Business Practice Location Address
First Line	:	1671 HOFFMAN RD STE 170
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-6232
Country	:	US
Telephone Number	:	920-288-2233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	08/20/2025

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