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1568134625
IAN BRODERICK GOUGH
CHICAGO, IL
NPI
1568134625
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: IL 178018226)
Additional Taxonomies
101Y00000X Counselor
Enumeration Date
2021-09-28
Last Update Date
2023-04-24
Business Address
IAN BRODERICK GOUGH MS, LPC
1616 N DAMEN AVE UNIT 301
CHICAGO, IL 60647-5536
Phone number: 888-303-2844
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Mailing Address
IAN BRODERICK GOUGH MS, LPC
1616 N DAMEN AVE UNIT 301
CHICAGO, IL 60647-5536
Phone number: 888-303-2844
Copy
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