Provider Demographics
NPI:1124392477
Name:PETERSON, ROBIN R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:R
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 LINCOLN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4149
Mailing Address - Country:US
Mailing Address - Phone:563-355-4879
Mailing Address - Fax:563-355-4879
Practice Address - Street 1:1035 LINCOLN RD
Practice Address - Street 2:STE 202
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4149
Practice Address - Country:US
Practice Address - Phone:563-355-4879
Practice Address - Fax:563-355-4879
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001232103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist