Provider Demographics
NPI:1104476373
Name:PEKEROL, ANNA LOUCHHEIM (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LOUCHHEIM
Last Name:PEKEROL
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 1:1114 ARCHANGEL WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-9626
Mailing Address - Country:US
Mailing Address - Phone:850-443-2875
Mailing Address - Fax:
Practice Address - Street 1:31 ROCKET DR
Practice Address - Street 2:
Practice Address - City:BLAND
Practice Address - State:VA
Practice Address - Zip Code:24315-4506
Practice Address - Country:US
Practice Address - Phone:276-688-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist