Provider Demographics
NPI:1881684645
Name:KNODEL, PEGGY (LMFT)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:
Last Name:KNODEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 E QUAIL RUN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-5059
Mailing Address - Country:US
Mailing Address - Phone:208-365-5445
Mailing Address - Fax:208-365-6226
Practice Address - Street 1:2007 E QUAIL RUN RD STE 1
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-5059
Practice Address - Country:US
Practice Address - Phone:208-365-5445
Practice Address - Fax:208-365-6226
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT24676106H00000X
IDLMFT6491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist