Healthcare Provider Details

I. General information

NPI: 1104046168
Provider Name (Legal Business Name): SUSAN C ENDES MS ATRL BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W WELLS ST
MILWAUKEE WI
53233
US

IV. Provider business mailing address

544 N 99 ST
WAUWATOSA WI
53226-4310
US

V. Phone/Fax

Practice location:
  • Phone: 414-937-2096
  • Fax: 414-937-2021
Mailing address:
  • Phone: 414-258-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number69036
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number69036
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: