Healthcare Provider Details

I. General information

NPI: 1649829573
Provider Name (Legal Business Name): PEGGY ZINSER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PEGGY KALTENBACH, KALTENBACH-PINGEL

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 N HAGGERTY RD STE 100
CANTON MI
48187-4472
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 734-738-1900
  • Fax: 734-738-1905
Mailing address:
  • Phone: 947-522-1861
  • Fax: 947-522-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007472
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: