Healthcare Provider Details

I. General information

NPI: 1508528886
Provider Name (Legal Business Name): CHING-HSUAN PENG MS/CFY-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 26TH AVE
MONROE WI
53566-1531
US

IV. Provider business mailing address

516 26TH AVE
MONROE WI
53566-1531
US

V. Phone/Fax

Practice location:
  • Phone: 608-325-9141
  • Fax:
Mailing address:
  • Phone: 608-325-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5374-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: