Provider Demographics
NPI:1285846840
Name:TAYLOR, PEGGY SUE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:SUE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 W GRAND CANYON DR
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-6020
Mailing Address - Country:US
Mailing Address - Phone:435-644-3372
Mailing Address - Fax:435-644-3372
Practice Address - Street 1:898 W GRAND CANYON DR
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-6020
Practice Address - Country:US
Practice Address - Phone:435-644-3372
Practice Address - Fax:435-644-3372
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5335545-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical