Provider Demographics
NPI:1194090639
Name:DANIEL GOECKNER PHD LLC
Entity type:Organization
Organization Name:DANIEL GOECKNER PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-241-9990
Mailing Address - Street 1:11649 N PORT WASHINGTON RD STE 206
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3459
Mailing Address - Country:US
Mailing Address - Phone:262-241-9990
Mailing Address - Fax:
Practice Address - Street 1:11649 N PORT WASHINGTON RD STE 206
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:262-241-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI850-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty