Provider Demographics
NPI:1902944259
Name:SZWABO, PEGGY A (PHD, MSW, RN)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:SZWABO
Suffix:
Gender:F
Credentials:PHD, MSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1701
Mailing Address - Country:US
Mailing Address - Phone:314-603-5339
Mailing Address - Fax:314-647-6305
Practice Address - Street 1:1201 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1701
Practice Address - Country:US
Practice Address - Phone:314-603-5339
Practice Address - Fax:314-647-6305
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0006071041C0700X
MO050732364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR01026Medicare UPIN