Provider Demographics
NPI:1043907686
Name:FITZWATER, PEGGY
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:FITZWATER
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:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-0034
Mailing Address - Country:US
Mailing Address - Phone:712-243-2606
Mailing Address - Fax:712-560-3889
Practice Address - Street 1:2307 OLIVE ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-9768
Practice Address - Country:US
Practice Address - Phone:712-243-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health