Provider Demographics
NPI:1598775405
Name:PEASLEE, AUNDREA MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:AUNDREA
Middle Name:MARIE
Last Name:PEASLEE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5051
Mailing Address - Country:US
Mailing Address - Phone:208-465-5433
Mailing Address - Fax:208-466-5802
Practice Address - Street 1:112 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5051
Practice Address - Country:US
Practice Address - Phone:208-465-5433
Practice Address - Fax:208-466-5802
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010153418Medicare UPIN
IDQ6082Medicare UPIN