Doctor Name: | MS. SARA JANE GOGERTY |
NPI Number: | 1427349414 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LMFT, LADC |
License Number: | 303027 |
Business Practice Address: | 8891 Broderick Blvd Apt 310 Inver Grove Heights, MN - 550765185 |
Business Phone Number: | 6516622789 |
Business Fax Number: | |
Mailing Address: | 8891 Broderick Blvd Apt 310, INVER GROVE HEIGHTS |
State: | MN |
Postal Code: | 550765185 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/25/2011 |
NPI Last Update Date: | 05/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 303027 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |