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General NPI Number Information
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NPI Number | 1043835671
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Entity Type | Organization
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Legal Business Name | SGW PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 7300 147TH ST W STE 103
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City | APPLE VALLEY
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State | MN
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Zip | 55124-7580
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Country | US
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Telephone | 651-493-9412
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Fax | 651-365-1040
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Provider Business Mailing Address
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Address Line | 7300 147TH ST W STE 103
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City | APPLE VALLEY
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State | MN
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Zip | 55124-7580
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Country | US
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Telephone | 651-493-9412
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Fax | 651-365-1040
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SHANNON MARIE GOECKE-WATSON
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Credential | PSYD, LP
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Telephone | 651-493-9412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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