Provider Demographics
NPI:1992832174
Name:LYON, PETER T (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:T
Last Name:LYON
Suffix:
Gender:M
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 1:202 S DUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1904
Mailing Address - Country:US
Mailing Address - Phone:847-997-4672
Mailing Address - Fax:847-259-7796
Practice Address - Street 1:202 S DUNTON AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1904
Practice Address - Country:US
Practice Address - Phone:847-997-4672
Practice Address - Fax:847-259-7796
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist