Provider Demographics
NPI:1043412737
Name:AXELROD, ELIZABETH DAUGHADAY (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DAUGHADAY
Last Name:AXELROD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5474
Mailing Address - Country:US
Mailing Address - Phone:414-332-7333
Mailing Address - Fax:
Practice Address - Street 1:5150 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-5474
Practice Address - Country:US
Practice Address - Phone:414-332-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2111057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIE98907Medicare UPIN