Provider Demographics
NPI:1316545452
Name:FAUSTI, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:FAUSTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7327 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-1143
Mailing Address - Country:US
Mailing Address - Phone:715-526-4700
Mailing Address - Fax:715-526-5542
Practice Address - Street 1:W7327 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-1143
Practice Address - Country:US
Practice Address - Phone:715-526-4700
Practice Address - Fax:715-526-5542
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19091-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10993OtherWISCONSIN LICENSED PROFESSIONAL COUNSELOR
WI1003150004Medicaid