Provider Demographics
NPI:1144210501
Name:HADAR, ILANA (PHD)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:HADAR
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:N21W24327 CUMBERLAND DR
Mailing Address - Street 2:UNIT N
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5825
Mailing Address - Country:US
Mailing Address - Phone:262-523-0204
Mailing Address - Fax:
Practice Address - Street 1:20700 WATERTOWN RD
Practice Address - Street 2:STE 206
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1800
Practice Address - Country:US
Practice Address - Phone:262-717-0077
Practice Address - Fax:262-717-0088
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI904057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical