Provider Demographics
NPI:1477541589
Name:FRANK, PEGGY JO (MA CCC-A)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JO
Last Name:FRANK
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 S. LAFAYETTE STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838
Mailing Address - Country:US
Mailing Address - Phone:616-225-9892
Mailing Address - Fax:616-225-9892
Practice Address - Street 1:322 S. LAFAYETTE STREET
Practice Address - Street 2:SUITE D
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838
Practice Address - Country:US
Practice Address - Phone:616-225-9892
Practice Address - Fax:616-225-9892
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002249237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI804675488Medicaid
MI640D113770OtherBCBS AUDIOLOGY GROUP
MI640D113780OtherBCBS AUDIOLOGY INDIVIDUAL
MI903471250Medicaid
MI540D113710OtherBCBS HEARING AID DEALER
MI804675488Medicaid