Individual
GERTRUDE MONGARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5701 KENTUCKY AVE N STE 100, CRYSTAL, MN 55428-3370
(763) 228-8086
Mailing address
5701 KENTUCKY AVE N STE 100, CRYSTAL, MN 55428-3370
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BIRTHDATE
01131992
—
Enumeration date
07/23/2020
Last updated
07/23/2020
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