Provider Demographics
NPI:1386932515
Name:PEPPENGER, CHARLEEN ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHARLEEN
Middle Name:ANN
Last Name:PEPPENGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHARLEEN
Other - Middle Name:ANN
Other - Last Name:HEINTZELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2935 STOCKYARD RD STE K4
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1567
Mailing Address - Country:US
Mailing Address - Phone:406-370-3839
Mailing Address - Fax:
Practice Address - Street 1:2935 STOCKYARD RD STE K4
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1567
Practice Address - Country:US
Practice Address - Phone:406-370-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical