Provider Demographics
NPI:1134224892
Name:LICHTENTHAL, PEGGY (AUD)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:LICHTENTHAL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PIN OAK CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1337
Mailing Address - Country:US
Mailing Address - Phone:716-773-0135
Mailing Address - Fax:
Practice Address - Street 1:3306 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1723
Practice Address - Country:US
Practice Address - Phone:716-874-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001558-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist