Healthcare Provider Details

I. General information

NPI: 1255397774
Provider Name (Legal Business Name): LORIE GOESER CADC, COTA, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 S 102ND ST STE 340 SUITE 3
MILWAUKEE WI
53227-2147
US

IV. Provider business mailing address

727 LORILLARD CT APT 212
MADISON WI
53703-3949
US

V. Phone/Fax

Practice location:
  • Phone: 414-329-2500
  • Fax: 414-329-2501
Mailing address:
  • Phone: 608-215-9114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number607-27
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1169
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: