Provider Demographics
NPI:1639267735
Name:BIBERDORF, PEGGY D (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:D
Last Name:BIBERDORF
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-1639
Mailing Address - Country:US
Mailing Address - Phone:701-775-2694
Mailing Address - Fax:
Practice Address - Street 1:290 CENTENNIAL DR
Practice Address - Street 2:STOP 8040
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-6063
Practice Address - Country:US
Practice Address - Phone:701-777-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist