Provider Demographics
NPI:1548619828
Name:FAUST, SHELI (PC, SAC-IT)
Entity type:Individual
Prefix:
First Name:SHELI
Middle Name:
Last Name:FAUST
Suffix:
Gender:F
Credentials:PC, SAC-IT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 815
Mailing Address - Street 2:
Mailing Address - City:LAC DU FLAMBEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54538-0815
Mailing Address - Country:US
Mailing Address - Phone:715-588-4422
Mailing Address - Fax:715-588-1889
Practice Address - Street 1:3378 N. SCHILLEMAN RD
Practice Address - Street 2:
Practice Address - City:LAC DU FLAMBEAU
Practice Address - State:WI
Practice Address - Zip Code:54538-5453
Practice Address - Country:US
Practice Address - Phone:715-588-4422
Practice Address - Fax:715-588-1889
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17846-130101YA0400X
WI3127-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1548619828Medicaid