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General NPI Number Information
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NPI Number | 1992237176
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Entity Type | Individual
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Provider Name | LAUREN MARIE GOLLA PSYD
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Gender | Female
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 5115 N BILTMORE LN
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City | MADISON
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State | WI
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Zip | 53718-2161
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Country | US
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Telephone | 608-592-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 7974 UW HEALTH CT
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City | MIDDLETON
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State | WI
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Zip | 53562-5531
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6301017819
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301017819
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 6301017819
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 21123
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License Number State | WI
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