Individual
MRS. AMANDA DIANNE GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC
Contact information
Practice address
25 W LINCOLN AVE, CHARLESTON, IL 61920-3070
(217) 345-9600
Mailing address
125 W JACKSON AVE, CHARLESTON, IL 61920-1814
(618) 562-2449
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.002672
IL
Other
Enumeration date
10/20/2009
Last updated
10/20/2009
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