Provider Demographics
NPI:1407487135
Name:GOUGH, JULIE ANN (FPS)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:GOUGH
Suffix:
Gender:F
Credentials:FPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 MARION AVE NW STE 101
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3639
Mailing Address - Country:US
Mailing Address - Phone:330-737-2700
Mailing Address - Fax:330-493-6413
Practice Address - Street 1:323 MARION AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3639
Practice Address - Country:US
Practice Address - Phone:330-493-3313
Practice Address - Fax:330-493-6413
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist