Provider Demographics
NPI:1629377387
Name:MYERS, PEGGY LYNNE (LISW-S)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LYNNE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5559 RUSSELL FORK DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8326
Mailing Address - Country:US
Mailing Address - Phone:614-749-8086
Mailing Address - Fax:
Practice Address - Street 1:1890 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1637
Practice Address - Country:US
Practice Address - Phone:614-397-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040107771041C0700X
OHI0005610171M00000X
OHI.0005610-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator