Provider Demographics
NPI:1508140567
Name:STANLEY, PEGGY (LICSW, CHHS)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LICSW, CHHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16720 NORTH RD APT F104
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5989
Mailing Address - Country:US
Mailing Address - Phone:425-218-1131
Mailing Address - Fax:
Practice Address - Street 1:16720 NORTH RD APT F104
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-5989
Practice Address - Country:US
Practice Address - Phone:425-218-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALW602463391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health