Provider Demographics
NPI:1548219355
Name:PEGUES, TONI ANGELIA (LCSW)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:ANGELIA
Last Name:PEGUES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7344 SHELBY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5663
Mailing Address - Country:US
Mailing Address - Phone:801-432-8393
Mailing Address - Fax:
Practice Address - Street 1:3392 W 3500 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-2630
Practice Address - Country:US
Practice Address - Phone:801-969-3307
Practice Address - Fax:801-969-8841
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4892035-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical