Individual
MARY GOGGINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2607 N GRANDVIEW BLVD, SUITE 104, WAUKESHA, WI 53188-1686
(262) 402-7964
(262) 261-5062
Mailing address
2607 N GRANDVIEW BLVD, SUITE 104, WAUKESHA, WI 53188-1686
(262) 402-7964
(262) 261-5062
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15722-131
WI
1041C0700X
Clinical Social Worker
Primary
7947-123
WI
Other
Enumeration date
10/31/2012
Last updated
02/28/2014
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