MEDICARE: MS. PEGGY SUE FLANAGAN LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW00004345	WA

General Provider Information

NPI Number	:	1841231479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PEGGY SUE FLANAGAN LICSW

Provider Business Mailing Address
First Line	:	22705 SE 21ST PL
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98075-9581
Country	:	US
Telephone Number	:	425-392-9744
Fax Number	:	425-391-0846

Provider Business Practice Location Address
First Line	:	1601 116TH AVE NE
Second Line	:	SUITE 104
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3010
Country	:	US
Telephone Number	:	425-941-3736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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