Provider Demographics
NPI:1558550202
Name:PEKNY, SHARLENE E (MS CCC-A)
Entity Type:Individual
Prefix:MS
First Name:SHARLENE
Middle Name:E
Last Name:PEKNY
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4413
Mailing Address - Country:US
Mailing Address - Phone:712-322-8393
Mailing Address - Fax:712-322-2660
Practice Address - Street 1:530 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4413
Practice Address - Country:US
Practice Address - Phone:712-322-8393
Practice Address - Fax:712-322-2660
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00010231H00000X
IA00297237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0126078Medicaid
IAI5121OtherMEDICARE