Lori-ana Elisa Guillen, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Burlington, Wisconsin. Her current practice location is
615 N Pine St Ste 202, Burlington, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(414) 666-4211.
Lori-ana Elisa Guillen is licensed to practice in Wisconsin (license number 11306-123) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1366127714.
Healthcare Provider's Profile
| Full Name | Lori-ana Elisa Guillen |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 615 N Pine St Ste 202, Burlington, Wisconsin |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1366127714
- Provider Enumeration Date: 06/21/2023
- Last Update Date: 03/20/2026
Medicare PECOS Information:
- PECOS PAC ID: 4183165848
- Enrollment ID: I20241007001680
Medical Identifiers
Medical identifiers for Lori-ana Elisa Guillen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1366127714 | NPI | - | NPPES |
| 11306123 | Medicaid | WI | |
| 15683462 | Other | WI | CAQH |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | 11306123 (Wisconsin) | Secondary |
| 1041C0700X | Social Worker - Clinical | 11306-123 (Wisconsin) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Lori-ana Elisa Guillen allows following entities to bill medicare on her behalf.
| Entity Name | Brave Changes, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1972339935
PECOS PAC ID: 3274074935
Enrollment ID: O20240920002320 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lori-ana Elisa Guillen is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Lori-ana Elisa Guillen, LCSW
7250 S Ballpark Dr Apt 106,
Franklin, WI 53132-7026
Ph: (786) 217-2642 | Lori-ana Elisa Guillen, LCSW
615 N Pine St Ste 202,
Burlington, WI 53105-1492
Ph: (414) 666-4211 |
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