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General NPI Number Information
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NPI Number | 1518381235
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Entity Type | Organization
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Legal Business Name | PEGGY MAKI PHD LLC
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Dates
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Enumeration Date | 02/17/2014
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 10520 WAYZATA BLVD #100
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City | MINNETONKA
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State | MN
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Zip | 55305-1511
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Country | US
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Telephone | 612-819-2750
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Fax |
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Provider Business Mailing Address
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Address Line | 10520 WAYZATA BLVD #100
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City | MINNETONKA
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State | MN
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Zip | 55305-1511
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Country | US
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Telephone | 612-819-2750
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Fax |
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Authorized Official
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Title or Position | OWNER AND PSYCHOLOGIST
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Name | PEGGY SUSAN MAKI
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Credential |
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Telephone | 612-819-2750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP 5729
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License Number State | MN
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