Provider Demographics
NPI:1578975199
Name:KUBIAK, PEGGY (LPC-T, SAC-IT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:KUBIAK
Suffix:
Gender:F
Credentials:LPC-T, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 GWYNN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1008
Mailing Address - Country:US
Mailing Address - Phone:920-471-9680
Mailing Address - Fax:
Practice Address - Street 1:2920 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-1594
Practice Address - Country:US
Practice Address - Phone:920-471-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16094-132101YA0400X
WI17125-130101YA0400X
WI6067-125101YM0800X, 101YP2500X
WI2141-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional