Provider Demographics
NPI:1487866455
Name:ENDE, ALLYSON R (PSYD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:R
Last Name:ENDE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 HIGHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-8131
Mailing Address - Country:US
Mailing Address - Phone:715-574-4805
Mailing Address - Fax:
Practice Address - Street 1:227500 RIB MOUNTAIN DR STE 103
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5052
Practice Address - Country:US
Practice Address - Phone:715-348-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006207103TC0700X
WI3264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical