Provider Demographics
NPI:1578918330
Name:PEGGY WOLNER, LICSW, LLC
Entity Type:Organization
Organization Name:PEGGY WOLNER, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WOLNER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-327-2470
Mailing Address - Street 1:2000 OLD WEST MAIN STREET
Mailing Address - Street 2:SUITE 311
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1988
Mailing Address - Country:US
Mailing Address - Phone:651-327-2470
Mailing Address - Fax:
Practice Address - Street 1:2000 OLD WEST MAIN STREET
Practice Address - Street 2:SUITE 311
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1988
Practice Address - Country:US
Practice Address - Phone:651-327-2470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN896251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health