Healthcare Provider Details

I. General information

NPI: 1164242855
Provider Name (Legal Business Name): PEGGY JO WALKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8447 PEORIA ST
SPRING HILL FL
34608-5450
US

IV. Provider business mailing address

8447 PEORIA ST
SPRING HILL FL
34608-5450
US

V. Phone/Fax

Practice location:
  • Phone: 615-418-6187
  • Fax:
Mailing address:
  • Phone: 615-418-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5337
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: