Provider Demographics
NPI:1467865659
Name:DUGAN, PETER (MED CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:DUGAN
Suffix:
Gender:M
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 TOWER DR APT 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5218
Mailing Address - Country:US
Mailing Address - Phone:502-710-1235
Mailing Address - Fax:
Practice Address - Street 1:501 TOWER DR APT 3
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5218
Practice Address - Country:US
Practice Address - Phone:502-710-1235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist