Provider Demographics
NPI:1194983544
Name:POWER, PEGGY COOK (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:COOK
Last Name:POWER
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LOUIS WILSON DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-3702
Mailing Address - Country:US
Mailing Address - Phone:601-825-6726
Mailing Address - Fax:601-825-6726
Practice Address - Street 1:301 LOUIS WILSON DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3702
Practice Address - Country:US
Practice Address - Phone:601-573-1856
Practice Address - Fax:601-825-6726
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSSO409235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00101371Medicaid