Healthcare Provider Details

I. General information

NPI: 1669743480
Provider Name (Legal Business Name): STEFANIE J. PECK, M.A. CCC-SLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 COCHRAN RD STE 2
SOLON OH
44139-3930
US

IV. Provider business mailing address

6325 COCHRAN RD STE 2
SOLON OH
44139-3930
US

V. Phone/Fax

Practice location:
  • Phone: 440-498-1100
  • Fax: 440-498-1149
Mailing address:
  • Phone: 440-498-1100
  • Fax: 440-498-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberSP6712
License Number StateOH

VIII. Authorized Official

Name: STEFANIE PECK
Title or Position: OWNER
Credential: SLP
Phone: 440-498-1100