Healthcare Provider Details

I. General information

NPI: 1285858811
Provider Name (Legal Business Name): JUDITH R. BUGH, MA, CCC SLP, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 DEAN ST RANDALLWOOD, SUITE O-1
ST CHARLES IL
60175-1066
US

IV. Provider business mailing address

38W118 HAWKINS LN
ST CHARLES IL
60175-6149
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-8980
  • Fax:
Mailing address:
  • Phone: 630-377-8980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: JUDITH RENEE BUGH
Title or Position: OWNER, PRESIDENT
Credential: MA. CCC SLP
Phone: 630-377-8980