Gough, Amanda Dianne

Gough, Amanda Dianne is an individual health care provider with primary practice located at 25 W Lincoln Ave , Charleston IL 61920-3070. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as her primary health care specialty. Gough, Amanda Dianne can be contacted via phone (217) 345-9600.

Contact Information

Primary practice address
25 W Lincoln Ave Charleston IL 61920-3070
Phone: (217) 345-9600
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X 096.002672 Illinois

Profile Details

NPI number 1710213178
LBN Legal business name Gough, Amanda Dianne
Credentials MS, ATC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 20th, 2009
Last updated Oct 20th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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