Individual
MARY BERYL GAGNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.A.
Contact information
Practice address
4929 W FOND DU LAC AVE, MILWAUKEE, WI 53216-2324
(414) 871-6122
Mailing address
4223 W MARTIN DR, APT. 302, MILWAUKEE, WI 53208-2762
(414) 933-7588
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/12/2007
Last updated
07/08/2007
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