Provider Demographics
NPI:1306980503
Name:PETERSON, PEGGY DEL (MS)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:DEL
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 ORONDO AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2828
Mailing Address - Country:US
Mailing Address - Phone:509-421-0120
Mailing Address - Fax:509-662-3919
Practice Address - Street 1:434 ORONDO AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2828
Practice Address - Country:US
Practice Address - Phone:509-421-0120
Practice Address - Fax:509-662-3919
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007822101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health