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General NPI Number Information
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NPI Number | 1538832936
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Entity Type | Organization
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Legal Business Name | PEGLAR LLC
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 1709 GOLDEN LAKE LOOP
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-5898
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Country | US
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Telephone | 561-603-4958
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Fax |
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Provider Business Mailing Address
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Address Line | 1709 GOLDEN LAKE LOOP
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-5898
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Country | US
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Telephone | 561-603-4958
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Fax |
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Authorized Official
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Title or Position | SLP
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Name | PEGGY LARSON
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Credential | M.S., CCC-SLP
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Telephone | 561-603-4958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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