MRS. AMANDA DIANNE GOUGH (NPI# 1710213178) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710213178 |
| Entity Type | Individual |
| Full Name | MRS. AMANDA DIANNE GOUGH |
| Credential | MS, ATC |
| Practice Address |
25 W Lincoln Ave Charleston IL 61920-3070 |
| Mailing Address |
125 W Jackson Ave Charleston IL 61920-1814 |
| Practice Telephone | 2173459600 |
| Mailing Telephone | 6185622449 |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2009-10-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
096.002672 | IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174172159 | Amanda A Gough | Social Worker | 3298 Veterans Dr, Traverse City, MI 49684-4725 | 2019-09-11 |
| 1316419609 | Amanda Marie Gough | Nurse Practitioner | 43184 Dequindre Rd, Sterling Heights, MI 48314-1709 | 2018-12-26 |
| Street Address |
25 W LINCOLN AVE |
| City | CHARLESTON |
| State | IL |
| Zip Code | 61920-3070 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063428977 | Charles L Schuster | Chiropractor | 25 W Lincoln Ave, Charleston, IL 61920-3016 | 2006-07-31 |
| 1407499189 | Shelby Brewer | Nurse Practitioner | 25 W Lincoln Ave, Charleston, IL 61920-3070 | 2019-10-24 |
| 1083736169 | Back To Health Physicians Group Ltd | Chiropractor | 25 W Lincoln Ave, Charleston, IL 61920-3016 | 2007-04-06 |
| 1336235647 | Janet L Baker | Registered Nurse | 25 W Lincoln Ave, Charleston, IL 61920-3070 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124643879 | Jenna Kay Mortensen | Speech-Language Pathologist | 2086 7th Street, Charleston, IL 61920 | 2020-06-09 |
| 1255954566 | Christina L. White | Nurse Practitioner | 1199 Persimmon Rd, Charleston, IL 61920 | 2020-05-20 |
| 1679066773 | Jennifer Hess | Specialist/Technologist | 2506 Lantz Building, Charleston, IL 61920 | 2018-06-13 |
| 1134647969 | Nichole C Ogilvie | Student in an Organized Health Care Education/Training Program | 917 4th Street Apt 19, Charleston, IL 61920 | 2017-08-31 |
| 1467970319 | Marcus Roach | Physical Therapy Assistant | 912 Oakcrest Dr. Apt D, Charleston, IL 61920 | 2017-08-30 |
| 1114478500 | 5 Guys Rx II LLC | Pharmacy | 1 W Lincoln Ave, Charleston, IL 61920 | 2016-10-20 |
| 1649723206 | Bright Minds Educational Program Inc | Developmental Therapist | 7704 Deerpath Road, Charleston, IL 61920 | 2016-08-01 |
| 1760843379 | Lisa Price | Nurse Practitioner | 2040 Lincoln Ave, Suite 100, Charleston, IL 61920 | 2016-03-09 |
| 1104243385 | Nathan David Schwartzkopf | Specialist/Technologist | 1340 A Street, Charleston, IL 61920 | 2014-03-25 |
| 1558694349 | Emily Schilling | Specialist/Technologist | 2350 Harrison Avenue, Charelston, IL 61920 | 2009-09-10 |
| Find all providers in zip 61920 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689291874 | Stephanie Davey | Specialist/Technologist | 1250 Marshview Dr, Charleston, SC 29412-8200 | 2020-07-03 |
| 1730704669 | Lester Groves Pittman | Specialist/Technologist | 1 Bishop Gadsden Way Apt 130, Charleston, SC 29412-3569 | 2020-06-16 |
| 1174159594 | Meagan B. Rasberry | Specialist/Technologist | 1047 Barbados Way, Charleston, SC 29412-8648 | 2020-03-17 |
| 1740744994 | Kalissa Bannister | Specialist/Technologist | 408 Jerick Cir, Charleston, WV 25302-4470 | 2019-01-22 |
| 1083188759 | Kailey Garten | Specialist/Technologist | 5242 Kanawha Blvd E, Charleston, WV 25306-6256 | 2019-01-16 |
| 1528532645 | Madyson Paige Hawley | Specialist/Technologist | 118 Shadowmoss Pkwy, Charleston, SC 29414-6845 | 2019-01-11 |
| 1174093413 | Perry Louisa Mcghee | Specialist/Technologist | 1390 Nottingham Rd, Charleston, WV 25314-2432 | 2018-11-29 |
| 1922575562 | Casandre Worsdorfer | Specialist/Technologist | 123 Presidio Pointe, Charleston, WV 25313-1591 | 2018-11-01 |
| 1679066773 | Jennifer Hess | Specialist/Technologist | 2506 Lantz Building, Charleston, IL 61920 | 2018-06-13 |
| 1144759689 | Julie Ann Bamberg | Specialist/Technologist | 1906 Gammon St, Charleston, SC 29414-8129 | 2017-06-08 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 61920 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.