Provider Demographics
NPI:1386849727
Name:RYAN, PEGGIE ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PEGGIE
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 COUNTY ROAD 545 N
Mailing Address - Street 2:
Mailing Address - City:SKANDIA
Mailing Address - State:MI
Mailing Address - Zip Code:49885-9583
Mailing Address - Country:US
Mailing Address - Phone:906-942-7678
Mailing Address - Fax:
Practice Address - Street 1:763 COUNTY ROAD 545 N
Practice Address - Street 2:
Practice Address - City:SKANDIA
Practice Address - State:MI
Practice Address - Zip Code:49885-9583
Practice Address - Country:US
Practice Address - Phone:906-942-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist