Basic Information
| Provider Information | |||||||||
| NPI: | 1295161743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAUGH | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5242 S 4820 W | ||||||||
| Address2: | |||||||||
| City: | KEARNS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841186422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019664251 | ||||||||
| FaxNumber: | 8019664289 | ||||||||
| Practice Location | |||||||||
| Address1: | 5242 S 4820 W | ||||||||
| Address2: | |||||||||
| City: | KEARNS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841186422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019664251 | ||||||||
| FaxNumber: | 8019664289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2013 | ||||||||
| LastUpdateDate: | 07/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 9039386-3501 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.