Angela Fellenz, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1138-140 Issued in WI

Practice address

371 E 1St St
Fond Du Lac, WI 54935-4563

Phone

(920) 907-3967

NPI assigned

Sep 30, 2020

Last updated

Sep 12, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1730796046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W2427 SNOWBERRY DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549157484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 E 1ST ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354563",
            "telephone_number": "920-907-3967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELLENZ",
        "first_name": "ANGELA",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-30",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "WI",
            "license": "0-20-11369",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "1138-140",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BACB CERTIFICATION #",
            "identifier": "0-20-11369",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEHAVIOR ANALYSIS CERTIFICATION BOARD",
            "identifier": "1-23-67656",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF WISCONSIN DIRECT LICENSING DEPT. OF SAFETY AND PROFESSIONAL SERVICES",
            "identifier": "1138-140",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Dean Farina, DC
• Joanne Christine Farrelly, FNP-BC
• Lisa M Faska, PT, MS
• Tricia May Fauska, CSAC
• Steven J. Feit, CRNA
• Karen Fennema, BCHIS
• Rachel Fennema, HIS
• Lindsey Mae Fergus-Renken, LPC
• Diane Fett
• Elizabeth Finch

• Behavior Analyst in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Behavior Analyst in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.