| Daniel Goeckner Phd Llc | |
|
11649 N Port Washington Rd Ste 206 Mequon WI 53092 | |
| (262) 241-9990 | |
| Not Available |
| Full Name | Daniel Goeckner Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 11649 N Port Washington Rd Ste 206, Mequon, Wisconsin |
| Authorized Official Name and Position | Daniel Goeckner (OWNER) |
| Authorized Official Contact | 2622419990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Daniel Goeckner Phd Llc 11649 N Port Washington Rd Ste 206 Mequon WI 53092-3459 Ph: (262) 241-9990 | Daniel Goeckner Phd Llc 11649 N Port Washington Rd Ste 206 Mequon WI 53092 Ph: (262) 241-9990 |
| NPI Number | 1194090639 |
|---|---|
| Provider Enumeration Date | 03/16/2012 |
| Last Update Date | 05/22/2018 |
| Medicare PECOS PAC ID | 4082877873 |
|---|---|
| Medicare Enrollment ID | O20120514000655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194090639 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 850-57 (Wisconsin) | Primary |
| Provider Name | Daniel J Goeckner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982687018 PECOS PAC ID: 9032301957 Enrollment ID: I20101011001078 |
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