Provider Demographics
NPI:1730498809
Name:THROCKMORTON, PEGGY LYNN
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LYNN
Last Name:THROCKMORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE #145
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3009
Mailing Address - Country:US
Mailing Address - Phone:480-686-8459
Mailing Address - Fax:
Practice Address - Street 1:1745 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE #145
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3009
Practice Address - Country:US
Practice Address - Phone:480-686-8459
Practice Address - Fax:480-855-8384
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA69662355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant