Provider Demographics
NPI:1982754420
Name:RUUD, PEGGY S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:S
Last Name:RUUD
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 1:1443 N VAGEDES AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-1411
Mailing Address - Country:US
Mailing Address - Phone:559-312-6553
Mailing Address - Fax:559-453-2420
Practice Address - Street 1:2307 N. FINE STREET, SUITE 114
Practice Address - Street 2:HOURGLASS BUILDING
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727
Practice Address - Country:US
Practice Address - Phone:559-312-6553
Practice Address - Fax:559-453-2420
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS149491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical