Provider Demographics
NPI:1295866879
Name:AMERICO, PETER KENT (MS CCC SLP)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:KENT
Last Name:AMERICO
Suffix:
Gender:M
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4408 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2506
Mailing Address - Country:US
Mailing Address - Phone:304-357-9058
Mailing Address - Fax:304-357-4412
Practice Address - Street 1:4408 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2506
Practice Address - Country:US
Practice Address - Phone:304-357-9058
Practice Address - Fax:304-357-4412
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist