Provider Demographics
NPI:1255840237
Name:PECK, KAREN RUTH (LCDC II , LPN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RUTH
Last Name:PECK
Suffix:
Gender:F
Credentials:LCDC II , LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 COLUMBUS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1331
Mailing Address - Country:US
Mailing Address - Phone:740-594-2276
Mailing Address - Fax:740-594-3105
Practice Address - Street 1:86 COLUMBUS RD STE 103
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1331
Practice Address - Country:US
Practice Address - Phone:740-594-2276
Practice Address - Fax:740-594-3105
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH102672164W00000X
OH161382101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No164W00000XNursing Service ProvidersLicensed Practical Nurse