Individual
SAMANTHA NICHOLE MOGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
15245 BLUEBIRD ST NW, ANDOVER, MN 55304-3538
(763) 587-4200
Mailing address
3178 253RD AVE NW, ISANTI, MN 55040-4321
(952) 594-5976
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
22141
MN
Other
Enumeration date
05/09/2023
Last updated
04/11/2024
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