Provider Demographics
NPI:1649264771
Name:KLEIN-ESCAMILLA, PEGGY A (LCSW)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:A
Last Name:KLEIN-ESCAMILLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4618
Mailing Address - Country:US
Mailing Address - Phone:307-638-1228
Mailing Address - Fax:307-433-0991
Practice Address - Street 1:520 E 18TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4618
Practice Address - Country:US
Practice Address - Phone:307-638-1228
Practice Address - Fax:307-433-0991
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-05
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-4371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY10066Medicare ID - Type Unspecified