Individual
CONSTANCE JO VANDERGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., L.P.
Contact information
Practice address
1930 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-4708
(763) 427-7964
(763) 427-7976
Mailing address
6867 SHERWOOD RD, WOODBURY, MN 55125-2483
(651) 340-5189
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LP2496
MN
Other
Enumeration date
10/13/2006
Last updated
10/24/2018
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