Provider Demographics
NPI:1487873790
Name:DUZAN, LORI (MA-LPC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DUZAN
Suffix:
Gender:F
Credentials:MA-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 REGENT ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-2634
Mailing Address - Country:US
Mailing Address - Phone:608-567-4465
Mailing Address - Fax:608-467-9004
Practice Address - Street 1:700 REGENT ST STE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-2634
Practice Address - Country:US
Practice Address - Phone:608-567-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3032-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40999100Medicaid