Provider Demographics
NPI:1356593636
Name:PESKLO, LYNNE MARY (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:MARY
Last Name:PESKLO
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 1:520 KNAPP HILL RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13744-1224
Mailing Address - Country:US
Mailing Address - Phone:607-760-2750
Mailing Address - Fax:
Practice Address - Street 1:520 KNAPP HILL RD
Practice Address - Street 2:
Practice Address - City:CASTLE CREEK
Practice Address - State:NY
Practice Address - Zip Code:13744-1224
Practice Address - Country:US
Practice Address - Phone:607-760-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012289-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist