Individual provider Active NPI

Eliza S Godfrey, PHD

  • Psychologist
  • Wauwatosa, WI
National Provider Identifier
1689354060
Registry record updated Sep 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
5351-57 Issued in WI
Practice address
1250 N 113TH St Ste 200
Wauwatosa, WI 53226-3209
Phone
(262) 432-6600
Fax
(262) 432-6604
NPI assigned
Jul 20, 2023
Last updated
Sep 3, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 5351-57 WI Primary

Addresses

Primary practice location

1250 N 113TH St Ste 200
Wauwatosa, WI 53226-3209

Mailing address

1250 N 113TH St Ste 200
Wauwatosa, WI 53226-3209
Phone (262) 432-6600

Other practice location 1

903 Mineral Point Ave
Janesville, WI 53548-2970
Phone (608) 756-5555

Other identifiers 1

IdentifierTypeStateIssuer
1689354060MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250916001661 WI Practitioner - Clinical Psychologist 0941704746 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

29624 Network PL
Chicago, IL 60673-1296

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation Current Accepting new patients
Mercy Health System Corporation CurrentSince Sep 15, 2025 Accepting new patients
Mercy Health System Corporation CurrentSince Sep 15, 2025 Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

903 Mineral Point Ave
Janesville, WI 53548
Phone (608) 756-5555

N2950 State Road 67
Lake Geneva, WI 53147
Phone (262) 245-0535

Interoperability endpoints

  • Direct secure messaging: egodfrey128828@direct.mhemail.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756857600000",
    "number": "1689354060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 N 113TH ST STE 200",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263209",
            "telephone_number": "262-432-6600",
            "fax_number": "262-432-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 N 113TH ST STE 200",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263209",
            "telephone_number": "262-432-6600",
            "fax_number": "262-432-6604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "903 Mineral Point Ave",
            "address_purpose": "LOCATION",
            "city": "Janesville",
            "state": "WI",
            "postal_code": "535482970",
            "country_code": "US",
            "telephone_number": "608-756-5555",
            "fax_number": "608-756-0174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GODFREY",
        "first_name": "ELIZA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-20",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "5351-57",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689354060",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.