Provider Demographics
NPI:1588626766
Name:WRIGHT-GOEHMANN, TERRY L (LCPC, RD, LD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:WRIGHT-GOEHMANN
Suffix:
Gender:F
Credentials:LCPC, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W GLENLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-1147
Mailing Address - Country:US
Mailing Address - Phone:847-913-3673
Mailing Address - Fax:630-980-9730
Practice Address - Street 1:102 W GLENLAKE AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-1147
Practice Address - Country:US
Practice Address - Phone:847-913-3673
Practice Address - Fax:630-980-9730
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered