MEDICARE: MS. PEGGY KNODEL LMFT

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
1	106H00000X	Marriage & Family Therapist	MFT24676	CA
2	106H00000X	Marriage & Family Therapist	LMFT6491	ID

General Provider Information

NPI Number	:	1881684645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PEGGY KNODEL LMFT

Provider Business Mailing Address
First Line	:	2007 E QUAIL RUN RD STE 1
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-5059
Country	:	US
Telephone Number	:	208-365-5445
Fax Number	:	208-365-6226

Provider Business Practice Location Address
First Line	:	2007 E QUAIL RUN RD STE 1
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-5059
Country	:	US
Telephone Number	:	208-365-5445
Fax Number	:	208-365-6226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	04/18/2022

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