Healthcare Provider Details

I. General information

NPI: 1295652121
Provider Name (Legal Business Name): ELLE LIEDER LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10427 W LINCOLN AVE STE 1800
WEST ALLIS WI
53227-1200
US

IV. Provider business mailing address

10427 W LINCOLN AVE STE 1800
WEST ALLIS WI
53227-1200
US

V. Phone/Fax

Practice location:
  • Phone: 414-361-2261
  • Fax: 262-895-2291
Mailing address:
  • Phone: 414-361-2261
  • Fax: 262-895-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9166-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: