Healthcare Provider Details

I. General information

NPI: 1366925331
Provider Name (Legal Business Name): MOLLY PECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PRAIRIE HAWK DR
CASTLE ROCK CO
80109-8001
US

IV. Provider business mailing address

2158 VILLAGEVIEW LN
CASTLE ROCK CO
80104-7608
US

V. Phone/Fax

Practice location:
  • Phone: 720-433-1258
  • Fax:
Mailing address:
  • Phone: 847-814-3467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number24399455
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.005129
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: