Provider Demographics
NPI:1568539237
Name:BEGEN-PELTZ, LINDA GAIL (MA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:GAIL
Last Name:BEGEN-PELTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:GAIL
Other - Last Name:BEGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:10 CLIPPER HL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2314
Mailing Address - Country:US
Mailing Address - Phone:510-849-2159
Mailing Address - Fax:510-849-2151
Practice Address - Street 1:2316 DWIGHT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2212
Practice Address - Country:US
Practice Address - Phone:510-845-4826
Practice Address - Fax:510-845-0360
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 24231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU24OtherSTATE LICENSE NUMBER
CAZZZ76218ZMedicaid