Peck, Laticia
Peck, Laticia is an sole proprietor health care provider with primary practice located at 1165 Pine Lake Dr , Grayson GA 30017-7926. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Peck, Laticia can be contacted via phone (678) 852-4022.Contact Information
Primary practice address
1165 Pine Lake Dr
Grayson GA 30017-7926
Phone: (678) 852-4022
Fax: (770) 972-5577
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | SLP005865 | Georgia |
Profile Details
| NPI number | 1104804574 |
|---|---|
| LBN Legal business name | Peck, Laticia |
| Credentials | SLP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 5th, 2006 |
| Last updated | Apr 28th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104804574 | NPPES |
| Georgia | MEDICAID | 371442378F |
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