=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346056520
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MORGAN ASHLEY CARTER-ENGSTRAND PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2024
-----------------------------------------------------
Last Update Date | 12/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2607 FIELDING LN APT 202
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53188-1487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-986-5921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2607 FIELDING LN APT 202
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53188-1487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-986-5921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 5237-57
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------