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Individual

JOHN DWIGHT FERGUSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LICSW

Contact information

Practice address
1340 81ST AVE NE, SPRING LAKE PARK, MN 55432-2116
(763) 783-4528
(763) 786-9729
Mailing address
5648 NEWTON AVE S, MINNEAPOLIS, MN 55419-1531
(612) 922-2993

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10199
MN

Other

Enumeration date
10/16/2006
Last updated
07/08/2007
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