Provider Demographics
NPI:1043346299
Name:CHACON, PEGGY LAVERNE (SLP)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LAVERNE
Last Name:CHACON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27437
Mailing Address - Street 2:STE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-7437
Mailing Address - Country:US
Mailing Address - Phone:505-503-8934
Mailing Address - Fax:505-503-8604
Practice Address - Street 1:301 PERKINS DR
Practice Address - Street 2:STE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3248
Practice Address - Country:US
Practice Address - Phone:505-642-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist