Provider Demographics
NPI:1376088195
Name:PECK, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2843 E GRAND RIVER AVE # 183
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6722
Mailing Address - Country:US
Mailing Address - Phone:269-598-6350
Mailing Address - Fax:
Practice Address - Street 1:300 BAILEY ST STE 2
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4444
Practice Address - Country:US
Practice Address - Phone:724-454-9024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker