Healthcare Provider Details

I. General information

NPI: 1699686758
Provider Name (Legal Business Name): ANNIE MAE PEYTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12914 N RAILWAY AVE APT 301
RATHDRUM ID
83858-1320
US

IV. Provider business mailing address

12914 N RAILWAY AVE APT 301
RATHDRUM ID
83858-1320
US

V. Phone/Fax

Practice location:
  • Phone: 208-771-7284
  • Fax:
Mailing address:
  • Phone: 208-771-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1181434
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: