Provider Demographics
NPI:1912775537
Name:KNAACK, PEGGY JO (LCSW)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JO
Last Name:KNAACK
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 1:705 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-4013
Mailing Address - Country:US
Mailing Address - Phone:309-737-5676
Mailing Address - Fax:
Practice Address - Street 1:705 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4013
Practice Address - Country:US
Practice Address - Phone:309-737-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0260451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical