Provider Demographics
NPI:1922534346
Name:ENGLISH, PEGGY M (LCDC III)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:M
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8985 TOWNSHIP ROAD 57 NE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43777-9661
Mailing Address - Country:US
Mailing Address - Phone:740-607-6853
Mailing Address - Fax:740-345-7454
Practice Address - Street 1:4000 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-334-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA 090353101YA0400X, 171M00000X
OH161738101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1922534346Medicaid