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General NPI Number Information
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NPI Number | 1215823778
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Entity Type | Individual
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Provider Name | KELLY ANN PECK
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Gender | Female
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 368 W UWCHLAN AVE
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-3319
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Country | US
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Telephone | 756-269-7568
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Fax |
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Provider Business Mailing Address
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Address Line | 10 FOUR LEAF DR
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-4041
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Country | US
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Telephone | 505-850-9152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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