MEDICARE: ABIGAIL A PECK LMSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801112454	MI

General Provider Information

NPI Number	:	1326500935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL A PECK LMSW-C

Provider Business Mailing Address
First Line	:	800 COTTAGEVIEW DR STE 1080B
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2496
Country	:	US
Telephone Number	:	231-442-0887
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 COTTAGEVIEW DR STE 1080B
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2496
Country	:	US
Telephone Number	:	231-632-0416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	07/27/2022

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