Provider Demographics
NPI:1932372323
Name:PECK, EMILY OSBORN (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:OSBORN
Last Name:PECK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9406
Mailing Address - Country:US
Mailing Address - Phone:630-721-6501
Mailing Address - Fax:
Practice Address - Street 1:311 MALLARD LN
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-9406
Practice Address - Country:US
Practice Address - Phone:630-721-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist