Provider Demographics
NPI:1962925941
Name:STEWART, PEGGY ANNE
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANNE
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11555 NE MCLOUGHLIN PKWY
Mailing Address - Street 2:
Mailing Address - City:CASCADE LOCKS
Mailing Address - State:OR
Mailing Address - Zip Code:97014-6633
Mailing Address - Country:US
Mailing Address - Phone:503-839-6061
Mailing Address - Fax:
Practice Address - Street 1:8915 SW CENTER ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6307
Practice Address - Country:US
Practice Address - Phone:503-501-5322
Practice Address - Fax:503-726-5323
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health