Provider Demographics
NPI:1992203426
Name:PEACH, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:PEACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LUDINGTON ST STE 301E
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3549
Mailing Address - Country:US
Mailing Address - Phone:906-233-7333
Mailing Address - Fax:
Practice Address - Street 1:1100 LUDINGTON ST STE 301E
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3549
Practice Address - Country:US
Practice Address - Phone:906-233-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-418091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical