| 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 |
|---|---|
| Provider Enumeration Date | 06/09/2020 |
| Last Update Date | 06/09/2020 |
| Certification Date | 06/09/2020 |
| Medicare PECOS PAC ID | 4486065026 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205307659 PECOS PAC ID: 2062758873 Enrollment ID: I20190116001290 |
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