Provider Demographics
NPI:1124063938
Name:PFORTNER, CAROLA (MA)
Entity type:Individual
Prefix:
First Name:CAROLA
Middle Name:
Last Name:PFORTNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RAYOVAC DR SUITE 010
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711
Mailing Address - Country:US
Mailing Address - Phone:608-270-1960
Mailing Address - Fax:608-270-1965
Practice Address - Street 1:700 RAYOVAC DR SUITE 010
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711
Practice Address - Country:US
Practice Address - Phone:608-270-1960
Practice Address - Fax:608-270-1965
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40979600Medicare ID - Type Unspecified