Individual
KEAN GIRESSE GOUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
177 W PRICE AVE, SOUTH SALT LAKE, UT 84115-4345
(801) 503-4369
Mailing address
177 W PRICE AVE, SOUTH SALT LAKE, UT 84115-4345
(801) 503-4369
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
F24-112840
UT
Other
Enumeration date
05/14/2024
Last updated
05/14/2024
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