Individual
BRENDEN MCGIBBON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
2120 PARK AVE, MINNEAPOLIS, MN 55404-3378
(612) 872-2000
(612) 871-1375
Mailing address
2120 PARK AVE, MINNEAPOLIS, MN 55404-3378
(612) 872-2000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
24309
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871089482
—
MN
Enumeration date
07/06/2018
Last updated
04/24/2019
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