Provider Demographics
NPI:1932589231
Name:GOLUEKE, COURTNEY (MS, PC-IT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GOLUEKE
Suffix:
Gender:F
Credentials:MS, PC-IT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:ITZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-9188
Mailing Address - Country:US
Mailing Address - Phone:608-445-4288
Mailing Address - Fax:608-424-9099
Practice Address - Street 1:619 RIVER ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508
Practice Address - Country:US
Practice Address - Phone:608-445-4288
Practice Address - Fax:608-424-9099
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2771-226104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2771-226OtherPC-IT