Provider Demographics
NPI:1740652825
Name:KUBIAK, PEGGY
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:KUBIAK
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 1:1946 N 13TH ST STE 420
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7264
Mailing Address - Country:US
Mailing Address - Phone:419-720-9247
Mailing Address - Fax:419-720-0304
Practice Address - Street 1:1946 N 13TH ST STE 420
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-7264
Practice Address - Country:US
Practice Address - Phone:419-720-9247
Practice Address - Fax:419-720-0304
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1501259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health