Provider Demographics
NPI:1568911238
Name:PEGNO, CATHERINE SIMMONS (M ED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SIMMONS
Last Name:PEGNO
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-627-6391
Mailing Address - Fax:516-627-2057
Practice Address - Street 1:10 LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:MANHASSET HILLS
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-627-6391
Practice Address - Fax:516-627-2057
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist