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Individual
BRETT ALICIA ENNEKING
Active
Individual
BRETT ALICIA ENNEKING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
20043128A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300015970
MEDICAID
IN
Enumeration date
06/25/2018
Last updated
02/13/2026
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