Provider Demographics
NPI:1023772936
Name:PECK ENG, MITCHELL JAY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:JAY
Last Name:PECK ENG
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MITCHELL
Other - Middle Name:JAY
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 RICHARDSON ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6363
Mailing Address - Country:US
Mailing Address - Phone:530-264-8838
Mailing Address - Fax:530-389-3338
Practice Address - Street 1:120 RICHARDSON ST UNIT 7
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6363
Practice Address - Country:US
Practice Address - Phone:530-264-8838
Practice Address - Fax:530-389-3338
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33873235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist