Provider Demographics
NPI:1336403682
Name:GOGUEN, RICCI ALISHA
Entity Type:Individual
Prefix:
First Name:RICCI
Middle Name:ALISHA
Last Name:GOGUEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RICCI
Other - Middle Name:ALISHA
Other - Last Name:HAUGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 FORTUNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1750
Mailing Address - Country:US
Mailing Address - Phone:508-478-0207
Mailing Address - Fax:508-634-6984
Practice Address - Street 1:318 E ROWAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1200
Practice Address - Country:US
Practice Address - Phone:509-844-4966
Practice Address - Fax:509-319-2338
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
WABA60928335103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist