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Individual

ELIZABETH MARIE BLAIR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSYD

Contact information

Practice address
5900 N PORT WASHINGTON RD, STE 230, GLENDALE, WI 53217
(414) 962-4048
(414) 962-4052
Mailing address
5900 N PORT WASHINGTON RD, STE 230, GLENDALE, WI 53217
(414) 962-4048
(414) 962-4052

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2121057
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
39125400
WI
Enumeration date
07/17/2006
Last updated
11/03/2016
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