Provider Demographics
NPI:1972654747
Name:PECK, STEFANIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 COCHRAN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3930
Mailing Address - Country:US
Mailing Address - Phone:440-498-1100
Mailing Address - Fax:440-498-1149
Practice Address - Street 1:6325 COCHRAN RD STE 2
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3930
Practice Address - Country:US
Practice Address - Phone:440-498-1100
Practice Address - Fax:440-498-1100
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6712235Z00000X
OHSP6712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty