Provider Demographics
NPI:1891753810
Name:CHITTICK, PEGGY E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:E
Last Name:CHITTICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16055 MEEKER WAY
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8116
Mailing Address - Country:US
Mailing Address - Phone:720-666-4490
Mailing Address - Fax:
Practice Address - Street 1:16055 MEEKER WAY
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8116
Practice Address - Country:US
Practice Address - Phone:720-666-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015702103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACH1741668OtherHIGHMARK BLUE SHIELD
PACH1741668OtherHIGHMARK BLUE SHIELD