Kayla Fazzari, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

7720-125 Issued in WI

Practice address

1432 W Forest Home Ave # 400
Milwaukee, WI 53204-3228

Phone

(414) 567-5400

Fax

(414) 567-5359

NPI assigned

Jul 8, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kaylafazzari@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Richard Kneip, PH.D., P.C.

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700

  WI

  Medicare reassignment
• Children'S Medical Group

  • Pediatrics Physician
  • Milwaukee, WI
  • NPI 1821738261

  Professional

  NPD
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Professional

  NPD
• Children'S Medical Group

  • Pediatrics Physician
  • Glendale, WI
  • NPI 1134394471
  NPD (past)

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

{
    "created_epoch": "1594166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1891313656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1432 W FOREST HOME AVE STE 400",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532043228",
            "telephone_number": "414-567-5400",
            "fax_number": "414-567-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1432 W FOREST HOME AVE # 400",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532043228",
            "telephone_number": "414-567-5400",
            "fax_number": "414-567-5359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "N168W20964 Main St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "WI",
            "postal_code": "530379634",
            "country_code": "US",
            "telephone_number": "262-510-4332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAZZARI",
        "first_name": "KAYLA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-08",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7720-125",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18558-130",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mandy R Fawcett, APNP
• Evgueni Fayn, MD
• Jestus Larenza Ramene Fayne
• Monique N Fayne, OWNER OF AFH
• Yolanda Denise Fayne, REGISTERED NURSE
• Mario Amik Fears, LMT
• Kelly L. Feavel, P.T.
• Jennifer Fechter
• Raymond T Fedderly, MD
• Patrice Renee Fedel, CNS

• Professional Counselor in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.