Healthcare Provider Details

I. General information

NPI: 1568109957
Provider Name (Legal Business Name): PATRICK ENGLE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 S. 76 STREET #305
GREENFIELD WI
53220-4364
US

IV. Provider business mailing address

4811 S 76TH ST STE 305
GREENFIELD WI
53220-4364
US

V. Phone/Fax

Practice location:
  • Phone: 262-236-7102
  • Fax:
Mailing address:
  • Phone: 414-325-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11374
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: