Provider Demographics
NPI:1205671708
Name:STOLTENBURG, PEYTON ELIZABETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:ELIZABETH
Last Name:STOLTENBURG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 S HUGHES AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6310
Mailing Address - Country:US
Mailing Address - Phone:605-280-6784
Mailing Address - Fax:
Practice Address - Street 1:8011 S CINNAMON RIDGE PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6466
Practice Address - Country:US
Practice Address - Phone:605-271-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1276-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist