Provider Demographics
NPI:1477507788
Name:PECK, SANDY LYNN (AUD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:LYNN
Last Name:PECK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 10 1/2 AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-5259
Mailing Address - Country:US
Mailing Address - Phone:320-654-8664
Mailing Address - Fax:320-230-7758
Practice Address - Street 1:1011 10 1/2 AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-5259
Practice Address - Country:US
Practice Address - Phone:320-654-8664
Practice Address - Fax:320-230-7758
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist