Individual
AMELIA KRISTINE GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
210 WASHINGTON ST, WAUSAU, WI 54403-5543
(715) 845-3637
Mailing address
210 WASHINGTON ST, WAUSAU, WI 54403-5543
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20449-130
WI
Other
Enumeration date
12/08/2023
Last updated
12/08/2023
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