Provider Demographics
NPI:1427174861
Name:SALCEDO, PEGGY LYNNE (PHD)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LYNNE
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:LYNNE
Other - Last Name:JACKSON-SALCEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:55 LAVERNE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0622
Mailing Address - Country:US
Mailing Address - Phone:559-289-0074
Mailing Address - Fax:559-233-2320
Practice Address - Street 1:936 N VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3428
Practice Address - Country:US
Practice Address - Phone:559-233-4590
Practice Address - Fax:559-233-2320
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17598103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL175980Medicare ID - Type Unspecified