Provider Demographics
NPI:1659565661
Name:PEGG, DENISE FEEHAN
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:FEEHAN
Last Name:PEGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:F
Other - Last Name:PEGG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1926 NE 36TH CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-4981
Mailing Address - Country:US
Mailing Address - Phone:352-368-1859
Mailing Address - Fax:352-368-1859
Practice Address - Street 1:1926 NE 36TH CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4981
Practice Address - Country:US
Practice Address - Phone:352-368-1859
Practice Address - Fax:352-368-1859
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS9297OtherBCBS