Provider Demographics
NPI:1336271113
Name:PECK-FROST, KATY STENTON (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:STENTON
Last Name:PECK-FROST
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:STENTON
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:519 ALABAMA ST
Mailing Address - Street 2:2
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-4948
Mailing Address - Country:US
Mailing Address - Phone:781-470-9493
Mailing Address - Fax:
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-644-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist