Basic Information
| Provider Information | |||||||||
| NPI: | 1144754326 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 765 | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446910765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303457949 | ||||||||
| FaxNumber: | 3303455218 | ||||||||
| Practice Location | |||||||||
| Address1: | 2685 ARMSTRONG RD | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303457949 | ||||||||
| FaxNumber: | 3303455218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2017 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.0024511 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.