Provider Demographics
NPI:1730391095
Name:NADENICHEK, PEGGY EILEEN (MED)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:EILEEN
Last Name:NADENICHEK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 DRY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WARRIORS MARK
Mailing Address - State:PA
Mailing Address - Zip Code:16877-6036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:253 EASTERLY PKWY STE 206
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6301
Practice Address - Country:US
Practice Address - Phone:814-235-1100
Practice Address - Fax:814-235-1101
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008070L103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001775739OtherPROMISE