Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3430-57 | WI |
Y | 103TC0700X | Clinical Psychologist | 3430-57 | WI |
NPI | 1003351016 |
---|---|
Provider Name | Carol Goulet |
First Address | Eau Claire, WI 54702-1510 |
Second Address | La Crosse, WI 54601-8806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2016 |
Last Update Date | 16/09/2020 |