Provider Demographics
NPI:1487731428
Name:PELTZ, PATRICIA J (MA, MSW, ACSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:PELTZ
Suffix:
Gender:F
Credentials:MA, MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LUDINGTON ST STE 303
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3500
Mailing Address - Country:US
Mailing Address - Phone:906-786-4733
Mailing Address - Fax:
Practice Address - Street 1:1100 LUDINGTON ST
Practice Address - Street 2:SUITE 303
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3542
Practice Address - Country:US
Practice Address - Phone:906-786-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010626261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800897137OtherBLUE CROSS BLUE SHIELD
MIP09130001Medicare ID - Type UnspecifiedMEDICARE MEMBER #