Provider Demographics
NPI:1104264241
Name:HEALTH OFFICE, CO.
Entity type:Organization
Organization Name:HEALTH OFFICE, CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:RN PHD GNP-BC CHTP/I
Authorized Official - Phone:715-598-4141
Mailing Address - Street 1:1417 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4808
Mailing Address - Country:US
Mailing Address - Phone:715-598-4141
Mailing Address - Fax:715-832-0225
Practice Address - Street 1:815 CHAPIN ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4317
Practice Address - Country:US
Practice Address - Phone:715-834-6302
Practice Address - Fax:715-834-5046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI325-33261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service