Provider Demographics
NPI:1295471944
Name:GOGUEN, ASHLEY (MS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GOGUEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MILL ST
Mailing Address - Street 2:BOX B-1
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1530
Mailing Address - Country:US
Mailing Address - Phone:802-373-6253
Mailing Address - Fax:
Practice Address - Street 1:1 MILL ST STE RLAB
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1530
Practice Address - Country:US
Practice Address - Phone:802-373-6253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0129237101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health