Sgw Psychological Services Llc | |
1585 Thomas Center Dr Eagan MN 55122-3007 | |
(952) 715-1149 | |
Not Available |
Full Name | Sgw Psychological Services Llc |
---|---|
Speciality | Psychologist |
Location | 1585 Thomas Center Dr, Eagan, Minnesota |
Authorized Official Name and Position | Shannon Marie Goecke-watson (PSYCHOLOGIST) |
Authorized Official Contact | 9527151149 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Sgw Psychological Services Llc 16280 Duskwood Trl Lakeville MN 55044-2418 Ph: (952) 715-1149 | Sgw Psychological Services Llc 1585 Thomas Center Dr Eagan MN 55122-3007 Ph: (952) 715-1149 |
NPI Number | 1043835671 |
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Provider Enumeration Date | 06/09/2020 |
Last Update Date | 06/09/2020 |
Certification Date | 06/09/2020 |
Medicare PECOS PAC ID | 4486065026 |
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Medicare Enrollment ID | O20201202003141 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043835671 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103T00000X | Psychologist | (* (Not Available)) | Primary |
Provider Name | Shannon M Goecke-watson |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1205307659 PECOS PAC ID: 2062758873 Enrollment ID: I20190116001290 |
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