Provider Demographics
NPI:1013249044
Name:CONNER, PEGGY S (MPHIL, MS,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:S
Last Name:CONNER
Suffix:
Gender:F
Credentials:MPHIL, MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 THEODORE FREMD AVENUE,
Mailing Address - Street 2:SUITE 206 SOUTH
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-1410
Mailing Address - Country:US
Mailing Address - Phone:914-925-3575
Mailing Address - Fax:
Practice Address - Street 1:411 THEODORE FREMD AVE
Practice Address - Street 2:SUITE 206 SOUTH
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-1410
Practice Address - Country:US
Practice Address - Phone:914-925-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist