Provider Demographics
NPI:1538148812
Name:LIGMAN, JEFFREY D (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:LIGMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10045 W LISBON AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2446
Mailing Address - Country:US
Mailing Address - Phone:414-358-7150
Mailing Address - Fax:414-393-1640
Practice Address - Street 1:10045 W LISBON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2446
Practice Address - Country:US
Practice Address - Phone:414-358-7150
Practice Address - Fax:414-393-1640
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI1281057103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1281-057OtherPSYCHOLOGIST LICENSE
WI39090200Medicaid
WI39090200Medicaid