Provider Demographics
NPI:1447408109
Name:DAN PETERSON, LTD
Entity Type:Organization
Organization Name:DAN PETERSON, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-420-2596
Mailing Address - Street 1:445 W JACKSON AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5256
Mailing Address - Country:US
Mailing Address - Phone:630-420-2596
Mailing Address - Fax:630-420-2597
Practice Address - Street 1:445 W JACKSON AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5256
Practice Address - Country:US
Practice Address - Phone:630-420-2596
Practice Address - Fax:630-420-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005898101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty