Provider Demographics
NPI:1831431816
Name:DUGAN, MARY KATHLEEN (B A)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:DUGAN
Suffix:
Gender:F
Credentials:B A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CLARE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2281
Mailing Address - Country:US
Mailing Address - Phone:502-439-1335
Mailing Address - Fax:
Practice Address - Street 1:3452 HUNTER CREEK DR
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-1114
Practice Address - Country:US
Practice Address - Phone:502-439-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator