Provider Demographics
NPI:1891584322
Name:FILLICETTI, EMILY ROSE (LAC, MSOM)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ROSE
Last Name:FILLICETTI
Suffix:
Gender:
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 FISHMAN RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-9247
Mailing Address - Country:US
Mailing Address - Phone:224-388-8970
Mailing Address - Fax:
Practice Address - Street 1:116 N DODGE ST STE 8A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1963
Practice Address - Country:US
Practice Address - Phone:224-388-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2081-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist