Provider Demographics
NPI:1225202914
Name:MORTON, ZELODIUS L (MS)
Entity Type:Individual
Prefix:MRS
First Name:ZELODIUS
Middle Name:L
Last Name:MORTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 WEST LISBON
Mailing Address - Street 2:SUITE B2
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210
Mailing Address - Country:US
Mailing Address - Phone:414-445-9797
Mailing Address - Fax:414-445-7979
Practice Address - Street 1:6040 W LISBON AVE
Practice Address - Street 2:SUITE B2
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2116
Practice Address - Country:US
Practice Address - Phone:414-445-9797
Practice Address - Fax:414-445-7979
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15364-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39178500Medicaid