Individual
ELIZABETH KAY GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
3324 W ELDER ST, BOISE, ID 83705-4713
(208) 577-1102
Mailing address
3324 W ELDER ST, BOISE, ID 83705-4713
(208) 577-1102
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-35822
ID
Other
Enumeration date
06/15/2016
Last updated
06/15/2016
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