Provider Demographics
NPI:1790015857
Name:PECK, MEGAN ALLEN (MED, MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ALLEN
Last Name:PECK
Suffix:
Gender:F
Credentials:MED, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6188 SAW MILL DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6559
Mailing Address - Country:US
Mailing Address - Phone:312-909-1822
Mailing Address - Fax:
Practice Address - Street 1:6188 SAW MILL DR
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-6559
Practice Address - Country:US
Practice Address - Phone:312-909-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IN99047651A1041C0700X
IN34007043A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist