Provider Demographics
NPI:1467582155
Name:PECK, NORMA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:JEAN
Last Name:PECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEANIE
Other - Middle Name:
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:714 E 400 N
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-1945
Mailing Address - Country:US
Mailing Address - Phone:435-752-1976
Mailing Address - Fax:435-755-6707
Practice Address - Street 1:965 S 100 W
Practice Address - Street 2:SUITE 203
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6062
Practice Address - Country:US
Practice Address - Phone:435-752-1976
Practice Address - Fax:435-755-6707
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT274552-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical