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NPI Code Detail

MEDICARE: PEGGY RUTH PAYONK LCSW

MEDICARE: PEGGY RUTH PAYONK LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34004369AIN

General Provider Information

NPI Number : 1699776625
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEGGY RUTH PAYONK LCSW
Provider Business Mailing Address
First Line : 8400 LOUISIANA ST
Second Line :
City : MERRILLVILLE
State : IN
Zip : 46410-6385
Country : US
Telephone Number : 219-757-1928
Fax Number : 219-757-1950
Provider Business Practice Location Address
First Line : 2490 CENTRAL AVE
Second Line : STE D
City : LAKE STATION
State : IN
Zip : 46405-2122
Country : US
Telephone Number : 219-962-4040
Fax Number : 219-960-4042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2005
Last Update Date : 05/25/2011

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