Provider Demographics
NPI:1841231479
Name:FLANAGAN, PEGGY SUE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:SUE
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22705 SE 21ST PL
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9581
Mailing Address - Country:US
Mailing Address - Phone:425-392-9744
Mailing Address - Fax:425-391-0846
Practice Address - Street 1:1601 116TH AVE NE
Practice Address - Street 2:SUITE 104
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3010
Practice Address - Country:US
Practice Address - Phone:425-941-3736
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000043451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical