Kenneth Gerard Fogal, MS VP

NPI #1104800960 in Crosby, Minnesota

Provider Information

NPI Number: 1104800960
Entity Type: Individual
Name: Kenneth Gerard Fogal, MS VP
Gender: Not Specified
Sole Proprietor: Not Answered
Primary Specialty: Psychologist
Credential: MS VP
Enumeration Date: Dec 5, 2005
Last Updated: Jul 8, 2007

Practice Location

Address: 318 E MAIN ST
Address 2: CENTRAL LAKES MEDICAL CLINIC ,PA
City: Crosby
State: Minnesota
ZIP Code: 56441-1691
Phone: (218) 546-8375

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist	103T00000X	Primary

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