Healthcare Provider Details

I. General information

NPI: 1972098861
Provider Name (Legal Business Name): WAYNE ENZENBERGER RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 W BELTLINE HWY STE 300
MADISON WI
53713-2934
US

IV. Provider business mailing address

1161 LAKE COOK RD
DEERFIELD IL
60015-5649
US

V. Phone/Fax

Practice location:
  • Phone: 608-819-6810
  • Fax: 608-819-6811
Mailing address:
  • Phone: 847-498-5437
  • Fax: 312-893-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: