Individual
KELSEY GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
1 SILVERCREST DR, NEW ALBANY, IN 47150-7800
(812) 913-5886
Mailing address
1521 CLIFTWOOD DR, CLARKSVILLE, IN 47129-1321
(517) 581-9647
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22007483A
IN
235Z00000X
Speech-Language Pathologist
263973
KY
235Z00000X
Speech-Language Pathologist
46003523A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235Z00000X
—
IN
Enumeration date
06/02/2019
Last updated
11/26/2020
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