Provider Demographics
NPI:1982577367
Name:GOULET, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GOULET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 SCHOONER DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9240
Mailing Address - Country:US
Mailing Address - Phone:773-793-3435
Mailing Address - Fax:
Practice Address - Street 1:20550 N LAGRANGE RD STE 210
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1495
Practice Address - Country:US
Practice Address - Phone:708-614-6860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0157151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical