Provider Demographics
NPI:1144396433
Name:ZACHER, PEGGY JO (PSY S)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:JO
Last Name:ZACHER
Suffix:
Gender:F
Credentials:PSY S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19601 N 7TH ST UNIT 2062
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1647
Mailing Address - Country:US
Mailing Address - Phone:602-493-6120
Mailing Address - Fax:602-493-6125
Practice Address - Street 1:17835 N 44TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1516
Practice Address - Country:US
Practice Address - Phone:602-493-6120
Practice Address - Fax:602-493-6125
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ808470Medicaid