Provider Demographics
NPI:1609448158
Name:ANDERSON, ELYSE ANN (MSW, APSW)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:ANN
Other - Last Name:KIPFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4799
Mailing Address - Country:US
Mailing Address - Phone:800-438-1772
Mailing Address - Fax:262-293-9737
Practice Address - Street 1:4531 W COLLEGE AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3928
Practice Address - Country:US
Practice Address - Phone:800-438-1772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132362-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker