Most Relevant Information
Provider Data
| NPI Number: | 1003321902 |
| Provider Name: | GLEN GAUGH LMSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 9206 |
Most Important Dates
| Enumeration Date: | 12/13/2017 |
| Last Updated: | 12/13/2017 |
Provider Practice Location
24 WEATHERFORD SQ
JACKSON
TN
383052202
Practice Location Phone/Fax
| Phone: | 7316606730 |
| Fax: |
Provider Mailing Location
24 WEATHERFORD SQ
JACKSON
TN
383052202
Provider Mailing Phone/Fax
| Phone: | 7316606730 |
| Fax: |