Provider Demographics
NPI:1114076528
Name:STEPHENS, PEGGY LYNNE (BC HIS)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:LYNNE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:BC HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:978-967-2732
Practice Address - Street 1:2428 4TH ST SW
Practice Address - Street 2:PLAZA WEST MALL
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-424-1111
Practice Address - Fax:641-424-6715
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0117044Medicaid