Individual
WARREN GOGGLEYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CD
Contact information
Practice address
604 S POKEGAMA AVE, GRAND RAPIDS, MN 55744-3831
(218) 327-9944
Mailing address
604 S POKEGAMA AVE, GRAND RAPIDS, MN 55744-3831
(218) 327-9944
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
302475
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302475
STATE LICENSE
MN
Enumeration date
04/28/2010
Last updated
04/28/2010
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