Provider Demographics
NPI:1225079957
Name:PUGH, KRISTINE D (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:D
Last Name:PUGH
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:MISS
Other - First Name:KRISTINE
Other - Middle Name:D
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7225 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4401
Mailing Address - Country:US
Mailing Address - Phone:314-752-3131
Mailing Address - Fax:314-752-3265
Practice Address - Street 1:7225 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4401
Practice Address - Country:US
Practice Address - Phone:314-752-3131
Practice Address - Fax:314-752-3265
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107775231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist