Mallory Engelhardt

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

12041110 Issued in WI

Practice address

371 E 1St St
Fond Du Lac, WI 54935-4563

Phone

(920) 907-3967

NPI assigned

Mar 16, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Agnesian Healthcare Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fond Du Lac, WI
  • NPI 1760902191
  NPD (past)

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

{
    "created_epoch": "1584316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1467088005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21600 OXNARD ST STE 1800",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913677807",
            "telephone_number": "818-345-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 E 1ST ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354563",
            "telephone_number": "920-907-3967"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5323 N 118th Ct",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532253085",
            "country_code": "US",
            "telephone_number": "414-296-5426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENGELHARDT",
        "first_name": "MALLORY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-16",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-20-4110",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "12041110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "356-140",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mallory.engelhardt@ssmhealth.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "371 E 1st St",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549354563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordyn Ellis
• Amy S Emmer-Sheldon, MD
• Martha A Endejan
• Therese Endres
• Oana Enea, D.O.
• Ephphatha Tiny Mouth Therapy LLC
• Connie Ernser
• Alan Ernst
• Jace Tanner Erwin, MD
• Essmann Counseling, LLC

• Behavior Analyst in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Behavior Analyst in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; 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.