Provider Demographics
NPI:1841303179
Name:PEGG, LYN CLARK (EDD, MS, LP)
Entity type:Individual
Prefix:MS
First Name:LYN
Middle Name:CLARK
Last Name:PEGG
Suffix:
Gender:F
Credentials:EDD, MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2425
Mailing Address - Country:US
Mailing Address - Phone:218-727-3770
Mailing Address - Fax:
Practice Address - Street 1:214 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1904
Practice Address - Country:US
Practice Address - Phone:218-722-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1419103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling