Healthcare Provider Details

I. General information

NPI: 1366127714
Provider Name (Legal Business Name): LORI-ANA ELISA GUILLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N PINE ST STE 202
BURLINGTON WI
53105-1492
US

IV. Provider business mailing address

7250 S BALLPARK DR APT 106
FRANKLIN WI
53132-7026
US

V. Phone/Fax

Practice location:
  • Phone: 414-666-4211
  • Fax:
Mailing address:
  • Phone: 786-217-2642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11306123
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11306-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: