Individual
BEVERLY GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
1635 W BIG BEAVER RD, TROY, MI 48084-3501
(248) 816-7000
(248) 928-0523
Mailing address
1635 W BIG BEAVER RD, TROY, MI 48084-3501
(248) 816-7000
(248) 928-0523
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6744-SL
MA
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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