| Doctor Name: | MRS. JENNIFER ANN GOULD |
| NPI Number: | 1457713588 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | RHF69605 |
| Business Practice Address: | 907 Ryan Street Chubbuck, ID - 83202 |
| Business Phone Number: | 4808232020 |
| Business Fax Number: | |
| Mailing Address: | 907 Ryan St, CHUBBUCK |
| State: | ID |
| Postal Code: | 832023027 |
| Phone Number: | 4808232020 |
| Fax Number: | |
| NPI Enumeration Date: | 03/28/2016 |
| NPI Last Update Date: | 03/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471C3402X |
| License Number: | RHF69605 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Radiography |
| Taxonomy Definition: | |