Gough, Jennifer

Gough, Jennifer is an individual health care provider with primary practice located at 4201 Dean Lakes Blvd Ste 160 , Shakopee MN 55379-2863. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavior Technician, which is considered as her primary health care specialty. Gough, Jennifer can be contacted via phone (612) 509-6680.

Contact Information

Primary practice address
4201 Dean Lakes Blvd Ste 160 Shakopee MN 55379-2863
Phone: (612) 509-6680
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X

Profile Details

NPI number 1013502038
LBN Legal business name Gough, Jennifer
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 2nd, 2021
Last updated Mar 2nd, 2021 - about 3 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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Identifiers

StateTypeNumberIssuer
All States NPI 1013502038 NPPES
Minnesota MEDICAID 1588993091

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