Provider Demographics
NPI:1285858811
Name:JUDITH R. BUGH, MA, CCC SLP, LTD.
Entity Type:Organization
Organization Name:JUDITH R. BUGH, MA, CCC SLP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:630-377-8980
Mailing Address - Street 1:38W118 HAWKINS LN
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6149
Mailing Address - Country:US
Mailing Address - Phone:630-377-8980
Mailing Address - Fax:
Practice Address - Street 1:2210 DEAN ST
Practice Address - Street 2:RANDALLWOOD, SUITE O-1
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1066
Practice Address - Country:US
Practice Address - Phone:630-377-8980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech