MEDICARE: NATHALIA MCPEAK

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	235Z00000X	Speech-Language Pathologist	2015026425	MO

General Provider Information

NPI Number	:	1417327826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALIA MCPEAK

Provider Business Mailing Address
First Line	:	3740 MARINE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-4175
Country	:	US
Telephone Number	:	314-533-0975
Fax Number	:

Provider Business Practice Location Address
First Line	:	3740 MARINE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-4175
Country	:	US
Telephone Number	:	314-533-0975
Fax Number	:

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

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	09/28/2015

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Directions to “ NATHALIA MCPEAK ” Practice Location

Language	Start Address	Practice Location

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