Provider Demographics
NPI:1033216775
Name:ENNIS, LOUISE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:M
Last Name:ENNIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7617 MINERAL POINT RD
Mailing Address - Street 2:STE300
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1623
Mailing Address - Country:US
Mailing Address - Phone:608-833-9290
Mailing Address - Fax:608-833-9691
Practice Address - Street 1:7617 MINERAL POINT RD
Practice Address - Street 2:STE300
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1623
Practice Address - Country:US
Practice Address - Phone:608-833-9290
Practice Address - Fax:608-833-9691
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2033-057103TC0700X
WI2033-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39728800Medicaid
WI840270030Medicare PIN