Provider Demographics
NPI:1972098861
Name:ENZENBERGER, WAYNE (RBT)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:ENZENBERGER
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 LAKE COOK RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5649
Mailing Address - Country:US
Mailing Address - Phone:847-498-5437
Mailing Address - Fax:312-893-2118
Practice Address - Street 1:3113 W BELTLINE HWY STE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2934
Practice Address - Country:US
Practice Address - Phone:608-819-6810
Practice Address - Fax:608-819-6811
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician