Individual
MONIQUE L GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3158 EATON RD, GREEN BAY, WI 54311-6827
(920) 770-3319
(920) 600-0271
Mailing address
3158 EATON RD, GREEN BAY, WI 54311-6827
(920) 819-3970
(920) 600-0271
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7158-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43562500
—
WI
Enumeration date
10/27/2005
Last updated
11/11/2023
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