Healthcare Provider Details

I. General information

NPI: 1942924857
Provider Name (Legal Business Name): PEGGY WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 LOGAN AVE
CHEYENNE WY
82001-5138
US

IV. Provider business mailing address

2811 CENTRAL AVE
CHEYENNE WY
82001-2701
US

V. Phone/Fax

Practice location:
  • Phone: 307-274-8086
  • Fax:
Mailing address:
  • Phone: 307-274-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-2358
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPAT-090
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: