Provider Demographics
NPI:1639557119
Name:BLAIS, PEGGY JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JEAN
Last Name:BLAIS
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 1:5816 IMAGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504
Mailing Address - Country:US
Mailing Address - Phone:907-317-6704
Mailing Address - Fax:
Practice Address - Street 1:5816 IMAGE CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4396
Practice Address - Country:US
Practice Address - Phone:907-317-6704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK666101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)