Provider Demographics
NPI:1245700715
Name:ENSTAD, EMILY (ATR, LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ENSTAD
Suffix:
Gender:F
Credentials:ATR, LPC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:ORDWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W7815 SHORE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-9754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W7815 SHORE ACRES RD
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-9754
Practice Address - Country:US
Practice Address - Phone:262-490-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X
WI6542-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist