Individual
BRIAN GARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOCIAL WORK
Contact information
Practice address
216 PARK AVE NW, PO BOX X, BAGLEY, MN 56621-9500
(218) 694-6164
(218) 694-3535
Mailing address
216 PARK AVE NW, PO BOX X, BAGLEY, MN 56621-9500
(218) 694-6164
(218) 694-3535
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27
SOCIAL SERVICES
—
Enumeration date
08/24/2011
Last updated
08/24/2011
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