Provider Demographics
NPI:1326244625
Name:WINGO, PEGGY (PHD,LLC)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:
Last Name:WINGO
Suffix:
Gender:F
Credentials:PHD,LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3936
Mailing Address - Country:US
Mailing Address - Phone:847-691-7533
Mailing Address - Fax:224-433-6998
Practice Address - Street 1:1248 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3936
Practice Address - Country:US
Practice Address - Phone:847-691-7533
Practice Address - Fax:224-433-6998
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical