Provider Demographics
NPI:1003033572
Name:PETERSON, ZOE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ZOE
Middle Name:D
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY BLVD
Mailing Address - Street 2:UNIVERSITY OF MISSOURI-ST. LOUIS
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4400
Mailing Address - Country:US
Mailing Address - Phone:314-516-7124
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY BLVD., COMMUNITY PSYCHOLOGICAL SERVICE
Practice Address - Street 2:UNIVERSITY OF MISSOURI-ST. LOUIS
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-516-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007036382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical