Individual provider Active NPI

Louise M Ennis, PHD

  • Clinical Psychologist
  • Madison, WI
National Provider Identifier
1033216775
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2033-57 Issued in WI
Practice address
7617 Mineral Point Rd
Ste300
Madison, WI 53717-1623
Phone
(608) 833-9290
Fax
(608) 833-9691
NPI assigned
Sep 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2033-057 WI
Clinical Psychologist 103TC0700X 2033-57 WI Primary

Addresses

Primary practice location

7617 Mineral Point Rd
Ste300
Madison, WI 53717-1623

Mailing address

7617 Mineral Point Rd
Ste300
Madison, WI 53717-1623
Phone (608) 833-9290

Other identifiers 1

IdentifierTypeStateIssuer
39728800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2033-057WIMDClinical Psychologist
2033-57WIMDClinical Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295395200000",
    "number": "1033216775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7617 MINERAL POINT RD",
            "address_2": "STE300",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171623",
            "telephone_number": "608-833-9290",
            "fax_number": "608-833-9691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7617 MINERAL POINT RD",
            "address_2": "STE300",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171623",
            "telephone_number": "608-833-9290",
            "fax_number": "608-833-9691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "LOUISE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-17",
        "last_updated": "2011-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2033-057",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2033-57",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39728800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.