Provider Demographics
NPI:1902469562
Name:GOSKESON, ABIGAIL (LICSW)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:GOSKESON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:GOSKESON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1625 MASSEE ST
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-5780
Mailing Address - Country:US
Mailing Address - Phone:507-383-6872
Mailing Address - Fax:
Practice Address - Street 1:123 S NEWTON AVE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2524
Practice Address - Country:US
Practice Address - Phone:507-383-6872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN177791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical