Provider Demographics
NPI:1194881136
Name:LINGARD, PEGGY (LCSW)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:LINGARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:SHIDELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7373 WEST LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3377
Mailing Address - Country:US
Mailing Address - Phone:855-268-4096
Mailing Address - Fax:
Practice Address - Street 1:1305 TOMMYDON ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3364
Practice Address - Country:US
Practice Address - Phone:855-268-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 219471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical