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NPI Code Detail

MEDICARE: MR. LEROY L PECHE M.S.W.

MEDICARE: MR. LEROY L PECHE M.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker696-123WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578678173
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LEROY L PECHE M.S.W.
Provider Business Mailing Address
First Line : 1641 W RIVER OAKS LN
Second Line :
City : MEQUON
State : WI
Zip : 53092-2638
Country : US
Telephone Number : 262-243-5679
Fax Number :
Provider Business Practice Location Address
First Line : 10850 W PARK PL
Second Line : SUITE 100
City : MILWAUKEE
State : WI
Zip : 53224-3606
Country : US
Telephone Number : 262-542-3255
Fax Number : 414-359-1021
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/09/2007

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