Provider Demographics
NPI:1760656300
Name:CROW, PEGGY SUE (DN)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:SUE
Last Name:CROW
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SPRING ST
Mailing Address - Street 2:SUITE 25
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-6407
Mailing Address - Country:US
Mailing Address - Phone:847-809-8252
Mailing Address - Fax:847-515-2997
Practice Address - Street 1:204 SPRING ST
Practice Address - Street 2:SUITE 25
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-6407
Practice Address - Country:US
Practice Address - Phone:847-809-8252
Practice Address - Fax:847-515-2997
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath