Provider Demographics
NPI:1699075697
Name:STONE, PEGGY L (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:L
Last Name:STONE
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 1:4631 NW 53RD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-3402
Mailing Address - Country:US
Mailing Address - Phone:352-373-5389
Mailing Address - Fax:
Practice Address - Street 1:4631 NW 53RD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-3402
Practice Address - Country:US
Practice Address - Phone:352-373-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 2284235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist