Provider Demographics
NPI:1467518324
Name:FITZPATRICK, PEGGY DIANE SR (SLP)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:DIANE
Last Name:FITZPATRICK
Suffix:SR
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 1:19550 BLYTH WAY
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-7977
Mailing Address - Country:US
Mailing Address - Phone:708-478-8714
Mailing Address - Fax:
Practice Address - Street 1:10071 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1272
Practice Address - Country:US
Practice Address - Phone:815-464-6069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist