Petty, Joel D

Petty, Joel D is an individual health care provider with primary practice located at 505 Broadway St , Baraboo WI 53913-2183. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Petty, Joel D can be contacted via phone (608) 355-4210.

Contact Information

Primary practice address
505 Broadway St Baraboo WI 53913-2183
Phone: (608) 355-4210
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1639212467
LBN Legal business name Petty, Joel D
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2007
Last updated Sep 11th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639212467 NPPES
Wisconsin Other 1025011 PHYSICIANS PLUS
Wisconsin Other 11991 PHYSICIANS PLUS
Wisconsin Other 39600574011 PHYSICIANS PLUS
Wisconsin MEDICAID 39784200 PHYSICIANS PLUS

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