Provider Demographics
NPI:1053331751
Name:PEACOCK, CHRISTINE NOELLE (MA, CCC-A)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:NOELLE
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 TAMIAMI TRL N STE 110
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5267
Mailing Address - Country:US
Mailing Address - Phone:239-434-2434
Mailing Address - Fax:
Practice Address - Street 1:1250 TAMIAMI TRL N STE 110
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5267
Practice Address - Country:US
Practice Address - Phone:239-434-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001103231H00000X
FLAY1869231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6447860011Medicare NSC
ILIL3270130Medicare PIN