MEDICARE: ANDREW FORMENTINI MS, ED

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	101YS0200X	School Counselor	3001023459	WI

General Provider Information

NPI Number	:	1851068977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW FORMENTINI MS, ED

Provider Business Mailing Address
First Line	:	1738 E IRON ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2312
Country	:	US
Telephone Number	:	847-372-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	1738 E IRON ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2312
Country	:	US
Telephone Number	:	847-372-4343
Fax Number	:

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

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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