Individual
MRS. KRISTINA MARIE PUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
13802 QUINTESSA ST, CALDWELL, ID 83607-5153
(801) 599-7123
Mailing address
13802 QUINTESSA ST, CALDWELL, ID 83607-5153
(801) 599-7123
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
I 0800088
OH
1041C0700X
Clinical Social Worker
Primary
LCSW-34310
ID
1041C0700X
Clinical Social Worker
X-07258
NM
Other
Enumeration date
06/24/2006
Last updated
04/18/2025
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