Provider Demographics
NPI:1447461918
Name:MATHEWSON, PEGGY (SLP)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:
Last Name:MATHEWSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:CREWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:777 MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-425-5497
Mailing Address - Fax:
Practice Address - Street 1:777 MONTEREY ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-425-5497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 5157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP 5157OtherSPEECH LANGUAGE PATHOLOGI