Individual provider Active NPI

Judith M. Haug, LCSW

  • Clinical Social Worker
  • Bridgeton, MO
National Provider Identifier
1376566372
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
002205 Issued in MO
Practice address
3165 McKelvey Rd
Suite 200
Bridgeton, MO 63044-2550
Phone
(314) 206-3453
Fax
(314) 206-3992
NPI assigned
Jul 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 002205 MO Primary

Addresses

Primary practice location

3165 McKelvey Rd
Suite 200
Bridgeton, MO 63044-2550

Mailing address

1430 Olive St
Suite400
Saint Louis, MO 63103-2303
Phone (314) 206-3453

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
002205MOMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376566372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 OLIVE ST",
            "address_2": "SUITE400",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631032303",
            "telephone_number": "314-206-3453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3165 MCKELVEY RD",
            "address_2": "SUITE 200",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442550",
            "telephone_number": "314-206-3453",
            "fax_number": "314-206-3992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUG",
        "first_name": "JUDITH",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "002205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.