Provider Demographics
NPI:1033622378
Name:PETERSON, VICTORIA ANN (RBT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:ANN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:22616 URSA MAJOR CIR
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5337
Mailing Address - Country:US
Mailing Address - Phone:805-377-2360
Mailing Address - Fax:805-377-2360
Practice Address - Street 1:22616 URSA MAJOR CIR
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5337
Practice Address - Country:US
Practice Address - Phone:805-377-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKRBT-17-42713106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician