Provider Demographics
NPI:1952767972
Name:DEARMOND, PEGGY
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:DEARMOND
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 1:26866 HIGHWAY S55
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50206-8086
Mailing Address - Country:US
Mailing Address - Phone:641-497-5294
Mailing Address - Fax:
Practice Address - Street 1:26866 HIGHWAY S55
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:IA
Practice Address - Zip Code:50206-8086
Practice Address - Country:US
Practice Address - Phone:641-497-5294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical