Provider Demographics
NPI:1003688540
Name:PEREGRINE THERAPY, PLLC
Entity Type:Organization
Organization Name:PEREGRINE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:IV
Authorized Official - Credentials:MS, MA, CCC-SLP
Authorized Official - Phone:765-476-3108
Mailing Address - Street 1:16770 NE 79TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4413
Mailing Address - Country:US
Mailing Address - Phone:425-689-8570
Mailing Address - Fax:425-689-7521
Practice Address - Street 1:16770 NE 79TH ST STE 105
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4413
Practice Address - Country:US
Practice Address - Phone:425-689-8570
Practice Address - Fax:425-689-7521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty