Provider Demographics
NPI:1063729986
Name:HUTSON, PEGGY ANN
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:ANN
Last Name:HUTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:IL
Mailing Address - Zip Code:62441-1217
Mailing Address - Country:US
Mailing Address - Phone:217-549-9408
Mailing Address - Fax:
Practice Address - Street 1:413 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-1217
Practice Address - Country:US
Practice Address - Phone:217-549-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist