Provider Demographics
NPI:1518381235
Name:PEGGY MAKI PHD LLC
Entity Type:Organization
Organization Name:PEGGY MAKI PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-819-2750
Mailing Address - Street 1:10520 WAYZATA BLVD
Mailing Address - Street 2:#100
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1511
Mailing Address - Country:US
Mailing Address - Phone:612-819-2750
Mailing Address - Fax:
Practice Address - Street 1:10520 WAYZATA BLVD
Practice Address - Street 2:#100
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1511
Practice Address - Country:US
Practice Address - Phone:612-819-2750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 5729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty