Provider Demographics
NPI:1922128693
Name:ANDERSON, PEGGY L (PLADC)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 S WESTCOTT ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-1063
Mailing Address - Country:US
Mailing Address - Phone:712-223-2270
Mailing Address - Fax:
Practice Address - Street 1:204 1ST ST
Practice Address - Street 2:SUITE A5
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-8588
Practice Address - Country:US
Practice Address - Phone:712-943-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-431101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)