MEDICARE: MS. ELIZABETH ANNE PUGH ED.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	OH3199658	OH

General Provider Information

NPI Number	:	1366801565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ANNE PUGH ED.S.

Provider Business Mailing Address
First Line	:	6009 DUNHAM RD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-4468
Country	:	US
Telephone Number	:	216-438-6030
Fax Number	:	216-587-4376

Provider Business Practice Location Address
First Line	:	6009 DUNHAM RD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-4468
Country	:	US
Telephone Number	:	216-438-6030
Fax Number	:	216-587-4376

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	02/16/2016

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