Healthcare Provider Details

I. General information

NPI: 1134321573
Provider Name (Legal Business Name): WENDY ANNE PECK L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 5TH AVE SUITE 205I
NAPERVILLE IL
60563-8965
US

IV. Provider business mailing address

2S371 HARTER RD
ELBURN IL
60119-9773
US

V. Phone/Fax

Practice location:
  • Phone: 630-779-0751
  • Fax: 630-753-0942
Mailing address:
  • Phone: 630-557-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: