Provider Demographics
NPI:1649367012
Name:GOUGH, KARI (LCSW)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:GOUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1132
Mailing Address - Country:US
Mailing Address - Phone:708-243-6737
Mailing Address - Fax:708-784-2056
Practice Address - Street 1:3821 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1132
Practice Address - Country:US
Practice Address - Phone:708-243-6737
Practice Address - Fax:708-784-2056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical