Provider Demographics
NPI:1528251881
Name:PEACHEY, MARILYN KAY (MS)
Entity type:Individual
Prefix:MISS
First Name:MARILYN
Middle Name:KAY
Last Name:PEACHEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 KING RANCH LN SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-5310
Mailing Address - Country:US
Mailing Address - Phone:505-620-0565
Mailing Address - Fax:
Practice Address - Street 1:10000 KING RANCH LN SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5310
Practice Address - Country:US
Practice Address - Phone:505-620-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist