Provider Demographics
NPI:1700211331
Name:GRENDAHL RISINGER, EMILY ELESE (MS)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ELESE
Last Name:GRENDAHL RISINGER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ELESE
Other - Last Name:GRENDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1128 ELM LAWN ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3032
Mailing Address - Country:US
Mailing Address - Phone:507-269-7672
Mailing Address - Fax:
Practice Address - Street 1:3015 N 114TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4208
Practice Address - Country:US
Practice Address - Phone:414-431-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor