Individual
DR. GARY L. GROGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
633 MAIN STREET, B#1, LEWISTON, ID 83501
(208) 724-0489
Mailing address
633 MAIN STREET B#1, LEWISTON, ID 83501
(208) 724-0489
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY-203016
ID
Other
Enumeration date
12/17/2014
Last updated
07/21/2022
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