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General NPI Number Information
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NPI Number | 1922472125
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Entity Type | Individual
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Provider Name | DANELL PUGH
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Gender | Female
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Dates
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Enumeration Date | 11/25/2015
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Last Update Date | 11/25/2015
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Provider Practice Location Address
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Address Line | BLDG 1657
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City | FORT CARSON
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State | CO
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Zip | 80913
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Country | US
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Telephone | 719-322-6439
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Fax |
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Provider Business Mailing Address
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Address Line | 4519 FENCER RD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80911-3619
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Country | US
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Telephone | 719-322-6439
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW.0009920785
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW-2251
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License Number State | HI
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