Provider Demographics
NPI:1780739748
Name:HESSE, PEGGY SUE (LP)
Entity type:Individual
Prefix:DR
First Name:PEGGY SUE
Middle Name:
Last Name:HESSE
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S 2ND ST
Mailing Address - Street 2:STE 306
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3639
Mailing Address - Country:US
Mailing Address - Phone:507-387-1350
Mailing Address - Fax:507-387-6605
Practice Address - Street 1:209 S 2ND ST
Practice Address - Street 2:SUITE 306
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3626
Practice Address - Country:US
Practice Address - Phone:507-387-1350
Practice Address - Fax:507-387-6605
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN393553100Medicaid
MN6145480OtherUNITED BEHAVORIAL HEALTH
MNHP28748OtherHEALTH PARTNERS
MN1021815OtherPREFERRED ONE
MN114894OtherUCARE
MN6H524HEOtherBLUE CROSS
MNHP28748OtherHEALTH PARTNERS