Provider Demographics
NPI:1689909335
Name:GOERGEN, LAURA L (LPC, CSAC, CSW, ICS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:GOERGEN
Suffix:
Gender:F
Credentials:LPC, CSAC, CSW, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 MERRILL AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2636
Mailing Address - Country:US
Mailing Address - Phone:715-680-0608
Mailing Address - Fax:715-907-1062
Practice Address - Street 1:1415 MERRILL AVE STE 210
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2636
Practice Address - Country:US
Practice Address - Phone:715-680-0608
Practice Address - Fax:715-907-1062
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9182-120104100000X
WI4221-125101YP2500X
WI15583101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)