Individual
MRS. GRETCHEN LYNN GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSCCC SLP
Contact information
Practice address
4102 BELMONT PT, CHAMPAIGN, IL 61822
(217) 366-0033
(217) 366-0012
Mailing address
PO BOX 6694, CHAMPAIGN, IL 61826-6694
(217) 366-0033
(217) 366-0012
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0146008599
IL
Other
Enumeration date
04/17/2007
Last updated
07/08/2007
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