Provider Demographics
NPI:1063973337
Name:PEEVY, ADRIAN RAY (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ADRIAN
Middle Name:RAY
Last Name:PEEVY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-2423
Mailing Address - Country:US
Mailing Address - Phone:210-365-2184
Mailing Address - Fax:
Practice Address - Street 1:1202 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-2423
Practice Address - Country:US
Practice Address - Phone:210-365-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
TX104151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist