Healthcare Provider Details

I. General information

NPI: 1144835265
Provider Name (Legal Business Name): KATHERYN LYNN GOLDBERG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERYN KNAPP LPC

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15285 WATERTOWN PLANK RD STE 102
ELM GROVE WI
53122-2339
US

IV. Provider business mailing address

15285 WATERTOWN PLANK RD STE 102
ELM GROVE WI
53122-2339
US

V. Phone/Fax

Practice location:
  • Phone: 414-207-8629
  • Fax:
Mailing address:
  • Phone: 414-207-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4729-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: