Provider Demographics
NPI:1265568935
Name:KEILHOLZ, PEGGY J (MSW)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:J
Last Name:KEILHOLZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7700 CLAYTON RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1328
Mailing Address - Country:US
Mailing Address - Phone:314-781-9181
Mailing Address - Fax:314-781-4883
Practice Address - Street 1:7700 CLAYTON RD
Practice Address - Street 2:SUITE 309
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1328
Practice Address - Country:US
Practice Address - Phone:314-781-9181
Practice Address - Fax:314-781-4883
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0013591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11567394OtherAETNA (CAQH)
MO057978OtherVALUE OPTIONS