Provider Demographics
NPI:1194578989
Name:SHERWIN, PEGGY RUTHALEEN
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:RUTHALEEN
Last Name:SHERWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MOUNTAIN LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2195
Mailing Address - Country:US
Mailing Address - Phone:636-293-0178
Mailing Address - Fax:
Practice Address - Street 1:28 MOUNTAIN LAUREL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2195
Practice Address - Country:US
Practice Address - Phone:636-293-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty