Provider Demographics
NPI:1053691105
Name:VIELLEUX, ANNETTE RENEE (PSYD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:RENEE
Last Name:VIELLEUX
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10045 W LISBON AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2446
Mailing Address - Country:US
Mailing Address - Phone:414-358-7157
Mailing Address - Fax:414-358-7158
Practice Address - Street 1:6190 STATE ROAD 36
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-9095
Practice Address - Country:US
Practice Address - Phone:414-331-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-21
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5466-125101YP2500X
WI3365-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3365-57OtherPSYCHOLOGIST LICENSE
WI5466-125OtherLPC LICENSE NUMBER
WI1275-226OtherPROFESSIONAL COUNSELOR TRAINING LICENSE