Provider Demographics
NPI:1366460115
Name:SCARGALL, PEGGY NIES (MSW, CADC, CAPSW)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:NIES
Last Name:SCARGALL
Suffix:
Gender:F
Credentials:MSW, CADC, CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 THACKERAY TRL STE 211
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4342
Mailing Address - Country:US
Mailing Address - Phone:262-613-0918
Mailing Address - Fax:262-646-6284
Practice Address - Street 1:888 THACKERAY TRL STE 211
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4342
Practice Address - Country:US
Practice Address - Phone:262-613-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12735104100000X
WI2011-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40929300Medicaid
390808738005OtherBLUE CROSS