Provider Demographics
NPI:1396747150
Name:AUDLEY, PEGGY LYNN (MSW)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LYNN
Last Name:AUDLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 COUNTY RD I
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-6916
Mailing Address - Country:US
Mailing Address - Phone:715-549-5404
Mailing Address - Fax:715-246-7778
Practice Address - Street 1:1221 COUNTY RD I
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-6916
Practice Address - Country:US
Practice Address - Phone:715-549-5404
Practice Address - Fax:715-246-7778
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI988-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical