Provider Demographics
NPI:1699846238
Name:PEYTON, MARY (SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PEYTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 ROY ST
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-1138
Mailing Address - Country:US
Mailing Address - Phone:320-839-4271
Mailing Address - Fax:320-839-4196
Practice Address - Street 1:1205 5TH AVE N
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MN
Practice Address - Zip Code:56296-4500
Practice Address - Country:US
Practice Address - Phone:320-563-8269
Practice Address - Fax:320-839-4196
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist