Provider Demographics
NPI:1780129783
Name:BALYEAT, PEGGY (LICSW)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:BALYEAT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W CASCADE WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6017
Mailing Address - Country:US
Mailing Address - Phone:509-489-4581
Mailing Address - Fax:509-482-0717
Practice Address - Street 1:123 W CASCADE WAY
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6017
Practice Address - Country:US
Practice Address - Phone:509-489-4581
Practice Address - Fax:509-482-0717
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical