| Doctor Name: | MARY GOGGINS |
| NPI Number: | 1033463849 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 15722-131 |
| Business Practice Address: | 2607 N Grandview Blvd Suite 104 Waukesha, WI - 531881686 |
| Business Phone Number: | 2624027964 |
| Business Fax Number: | 2622615062 |
| Mailing Address: | 2607 N Grandview Blvd, Suite 104 WAUKESHA |
| State: | WI |
| Postal Code: | 531881686 |
| Phone Number: | 2624027964 |
| Fax Number: | 2622615062 |
| NPI Enumeration Date: | 10/31/2012 |
| NPI Last Update Date: | 02/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 15722-131 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |