Peggy Diane Anderson
Individual provider Active NPI Speech-Language Pathologist · Bristol, IL
NPI 1831606789 · NPPES record last updated Jan 1, 2018
Key facts
- NPI
- 1831606789
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 399634 (IL)
- Practice address
- 23 Hunt St
Bristol, IL 60512-2003 - Phone
- (630) 553-4383
- NPI assigned
- Jan 1, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 399634 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 399634 | IL | Yes |
Addresses
Primary practice location
23 Hunt St
Bristol, IL 60512-2003
Mailing address
2616B Plainfield Rd
Oswego, IL 60543-9397
Phone (630) 554-1628
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 399634 | Other | IL | IEIN NUMBER |
Other providers in Bristol, IL
All providers in Bristol, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 1, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.