Provider Demographics
NPI:1497217921
Name:WEBER, PEGGY J (MS)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:J
Last Name:WEBER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PROFESSIONAL CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2159
Mailing Address - Country:US
Mailing Address - Phone:707-795-0830
Mailing Address - Fax:707-795-0820
Practice Address - Street 1:320 PROFESSIONAL CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2159
Practice Address - Country:US
Practice Address - Phone:707-795-0830
Practice Address - Fax:707-795-0820
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP1638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty