Healthcare Provider Details

I. General information

NPI: 1477081982
Provider Name (Legal Business Name): REBECCA JEANNE PECK M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA JEANNE SEROZYNSKI B.S.

II. Dates (important events)

Enumeration Date: 05/28/2017
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 BILLINGSLEY RD
COLUMBUS OH
43235-1990
US

IV. Provider business mailing address

6488 SAGEBRUSH CT
WESTERVILLE OH
43081-3720
US

V. Phone/Fax

Practice location:
  • Phone: 614-602-6473
  • Fax:
Mailing address:
  • Phone: 614-325-5341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: