Provider Demographics
NPI:1366679185
Name:PETERSON, HEATHER JOLEEN (MA, MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JOLEEN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MA, MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-0009
Mailing Address - Country:US
Mailing Address - Phone:717-676-1950
Mailing Address - Fax:
Practice Address - Street 1:10 CHEROKEE TRL
Practice Address - Street 2:
Practice Address - City:YORK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17370-8905
Practice Address - Country:US
Practice Address - Phone:717-676-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst