Healthcare Provider Details

I. General information

NPI: 1306070081
Provider Name (Legal Business Name): PEGGIE DICKENS ZUCKERMAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WINSTON WAY WEST #340
BAINBRIDGE ISLAND WA
98110
US

IV. Provider business mailing address

200 WINSTON WAY WEST #340
BAINBRIDGE ISLAND WA
98110
US

V. Phone/Fax

Practice location:
  • Phone: 206-795-2336
  • Fax:
Mailing address:
  • Phone: 206-795-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00059415
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00059415
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberRC00059415
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: