Healthcare Provider Details

I. General information

NPI: 1801768411
Provider Name (Legal Business Name): MADISON LORENZ LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W CAPITOL DR
MILWAUKEE WI
53222-1706
US

IV. Provider business mailing address

S44W25645 MARYANNA DR
WAUKESHA WI
53189-7709
US

V. Phone/Fax

Practice location:
  • Phone: 414-465-5570
  • Fax: 414-260-8980
Mailing address:
  • Phone: 414-465-5570
  • Fax: 414-260-8980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9179-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: