Healthcare Provider Details

I. General information

NPI: 1891753810
Provider Name (Legal Business Name): PEGGY E CHITTICK PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 MEEKER WAY
BROOMFIELD CO
80023-8116
US

IV. Provider business mailing address

16055 MEEKER WAY
BROOMFIELD CO
80023-8116
US

V. Phone/Fax

Practice location:
  • Phone: 720-666-4490
  • Fax:
Mailing address:
  • Phone: 720-666-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS015702
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: