Healthcare Provider Details

I. General information

NPI: 1952722399
Provider Name (Legal Business Name): PEGGY HUOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PEGGY HUOT LICSW

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 UNIVERSITY AVE E
SAINT PAUL MN
55130-4400
US

IV. Provider business mailing address

4872 GRENWICH TRL N
OAKDALE MN
55128-2029
US

V. Phone/Fax

Practice location:
  • Phone: 651-266-7900
  • Fax:
Mailing address:
  • Phone: 612-501-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14999
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: