Provider Demographics
NPI:1255397774
Name:GOESER, LORIE (CADC, COTA, CSAC)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:GOESER
Suffix:
Gender:F
Credentials:CADC, COTA, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 LORILLARD CT APT 212
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3949
Mailing Address - Country:US
Mailing Address - Phone:608-215-9114
Mailing Address - Fax:
Practice Address - Street 1:2448 S 102ND ST STE 340
Practice Address - Street 2:SUITE 3
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-2147
Practice Address - Country:US
Practice Address - Phone:414-329-2500
Practice Address - Fax:414-329-2501
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI607-27224Z00000X
WI1169101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant