Provider Demographics
NPI:1366781627
Name:ELSENRATH, DENNIS E (EDD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:E
Last Name:ELSENRATH
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 MAIN ST
Mailing Address - Street 2:STE 202
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-2848
Mailing Address - Country:US
Mailing Address - Phone:715-343-5256
Mailing Address - Fax:715-343-5899
Practice Address - Street 1:1052 MAIN ST
Practice Address - Street 2:STE 202
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2848
Practice Address - Country:US
Practice Address - Phone:715-343-5256
Practice Address - Fax:715-343-5899
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI453-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist