Provider Demographics
NPI:1720801418
Name:PEPPROCK, JOSEPH (EDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:PEPPROCK
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 2ND ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47932-1009
Mailing Address - Country:US
Mailing Address - Phone:765-231-3180
Mailing Address - Fax:
Practice Address - Street 1:1329 2ND ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:IN
Practice Address - Zip Code:47932-1009
Practice Address - Country:US
Practice Address - Phone:765-231-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10102174103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool