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Individual

KRYSTEN MCGOUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
6330 W THUNDERBIRD RD, GLENDALE, AZ 85306-4002
(406) 531-5402
Mailing address
31087 N 138TH AVE, PEORIA, AZ 85383-8041
(064) 531-5402

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
A01821
MD
2355S0801X
Speech-Language Assistant
Primary
SLPA12918
AZ

Other

Enumeration date
03/24/2011
Last updated
09/07/2021
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