Provider Demographics
NPI:1033288097
Name:MEYER, PEGGY ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANN
Last Name:MEYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:A
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:520 E 10TH ST
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978
Mailing Address - Country:US
Mailing Address - Phone:402-879-4432
Mailing Address - Fax:402-879-3401
Practice Address - Street 1:520 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978
Practice Address - Country:US
Practice Address - Phone:402-879-4432
Practice Address - Fax:402-879-3401
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2528101Y00000X
NE10591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025598800Medicaid
NE229138OtherMIDLANDS CHOICE
NE276355Medicare ID - Type Unspecified
NE229138OtherMIDLANDS CHOICE