Janette Susan Peterson
Psychologist, School in Leadore, ID. Individual provider (NPI-1).
NPI number1407433006
StatusActive
Last updated in NPPESMar 28, 2021
Details
- NPI
- 1407433006
- Entity type
- Individual (NPI-1)
- Name
- Janette Susan Peterson
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Mar 28, 2021
- Certification date
- Mar 28, 2021
- Last updated
- Mar 28, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TS0200X | Psychologist, School | 0000641145 | TN | Yes |
Practice location
27 Harvey LnLeadore, ID 83464-5035
Phone 208-303-0307
Mailing address
Po Box 58Leadore, ID 83464-0058
Phone 208-303-0307
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