Healthcare Provider Details

I. General information

NPI: 1285644625
Provider Name (Legal Business Name): SHERRY L PECK LPC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W MAIN ST
PORT WASHINGTON WI
53074-1813
US

IV. Provider business mailing address

121 W MAIN ST
PORT WASHINGTON WI
53074-1813
US

V. Phone/Fax

Practice location:
  • Phone: 262-284-8200
  • Fax: 262-284-8104
Mailing address:
  • Phone: 262-284-8200
  • Fax: 262-284-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3488
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3488-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: