Healthcare Provider Details

I. General information

NPI: 1962215400
Provider Name (Legal Business Name): TORY SKYE ELLIOTT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TORY SKYE MERTZ PHD

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5007 S HOWELL AVE STE 350
MILWAUKEE WI
53207-6159
US

IV. Provider business mailing address

3254 S KINNICKINNIC AVE
MILWAUKEE WI
53207-3120
US

V. Phone/Fax

Practice location:
  • Phone: 708-557-2108
  • Fax:
Mailing address:
  • Phone: 708-557-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5335-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: