Provider Demographics
NPI:1457090359
Name:GOSHGARIAN, ALISON JOY
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:JOY
Last Name:GOSHGARIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MANCHESTER RD STE 602
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4587
Mailing Address - Country:US
Mailing Address - Phone:630-480-0060
Mailing Address - Fax:
Practice Address - Street 1:2100 MANCHESTER RD STE 602
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4587
Practice Address - Country:US
Practice Address - Phone:630-480-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty