Healthcare Provider Details

I. General information

NPI: 1144540469
Provider Name (Legal Business Name): PEGGY VANDUYNE LPC, LPCC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 ALDRICH AVE S # 103
MINNEAPOLIS MN
55408-2334
US

IV. Provider business mailing address

2828 ALDRICH AVE S # 103
MINNEAPOLIS MN
55408-2334
US

V. Phone/Fax

Practice location:
  • Phone: 503-956-4506
  • Fax:
Mailing address:
  • Phone: 503-956-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2409
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: