Provider Demographics
NPI:1760580740
Name:AXELROOD, HELEN BLAU (PHD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:BLAU
Last Name:AXELROOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:BLAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:636 CHURCH ST
Mailing Address - Street 2:SUITE 321
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-492-1212
Mailing Address - Fax:847-256-7997
Practice Address - Street 1:636 CHURCH ST
Practice Address - Street 2:SUITE 321
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-492-1212
Practice Address - Fax:847-256-7997
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00219101YM0800X
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist