Provider Demographics
NPI:1538731849
Name:ORR, EMILY ELISE
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ELISE
Last Name:ORR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6617 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-4919
Mailing Address - Country:US
Mailing Address - Phone:262-358-2716
Mailing Address - Fax:
Practice Address - Street 1:8800 WASHINGTON AVE
Practice Address - Street 2:STE 100
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3743
Practice Address - Country:US
Practice Address - Phone:262-633-3591
Practice Address - Fax:262-633-2619
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional