Provider Demographics
NPI:1023160165
Name:POGGI, MARY JO ANN (MA LP)
Entity type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:ANN
Last Name:POGGI
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:MS
Other - First Name:JO
Other - Middle Name:ANN
Other - Last Name:POGGI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LP
Mailing Address - Street 1:4168 CASHELL GLEN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122
Mailing Address - Country:US
Mailing Address - Phone:651-686-9081
Mailing Address - Fax:
Practice Address - Street 1:6950 FRANCE AVE SO
Practice Address - Street 2:SUITE 103
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-922-9032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1834103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
83A55POOtherBLUE CROSS