Provider Demographics
NPI:1346318276
Name:HUNTER, ELLYN (MA)
Entity Type:Individual
Prefix:MS
First Name:ELLYN
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 S. YELLOWSTONE DR.
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1061
Mailing Address - Country:US
Mailing Address - Phone:608-219-9561
Mailing Address - Fax:608-630-8210
Practice Address - Street 1:437 S. YELLOWSTONE DR.
Practice Address - Street 2:SUITE 209
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1061
Practice Address - Country:US
Practice Address - Phone:608-219-9561
Practice Address - Fax:608-630-8210
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1290-125101YP2500X
WI419-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39660700Medicaid