Healthcare Provider Details

I. General information

NPI: 1962085217
Provider Name (Legal Business Name): ELENA DE LOS SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 W LAWRENCE ST STE 3
APPLETON WI
54914-4274
US

IV. Provider business mailing address

3215 W LAWRENCE ST STE 3
APPLETON WI
54914-4274
US

V. Phone/Fax

Practice location:
  • Phone: 920-441-2082
  • Fax:
Mailing address:
  • Phone: 920-441-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: