Provider Demographics
NPI:1093740706
Name:MCKNIGHT, PEGGY SUE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:SUE
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MRS
Other - First Name:PEGGY
Other - Middle Name:SUE
Other - Last Name:KIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:25101 CHAGRIN BOULEVARD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEECHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-831-6611
Mailing Address - Fax:216-456-8128
Practice Address - Street 1:4212 OHIO STATE ROUTE 306
Practice Address - Street 2:SUITE 100
Practice Address - City:WILOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:216-831-6611
Practice Address - Fax:216-456-8128
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI80921041C0700X
OHI.0008092-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical