Healthcare Provider Details

I. General information

NPI: 1376460592
Provider Name (Legal Business Name): CHRISTOPHER SCOTT GOETSCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 HUNTINGTON AVE
WISCONSIN RAPIDS WI
54494-6364
US

IV. Provider business mailing address

6320 TIMBERLINE WAY
WISCONSIN RAPIDS WI
54494-8001
US

V. Phone/Fax

Practice location:
  • Phone: 715-818-6443
  • Fax:
Mailing address:
  • Phone: 608-617-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9016-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: