Provider Demographics
NPI:1528401379
Name:PETERS, PAULA E (LSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:E
Last Name:PETERS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:E
Other - Last Name:CHIAPPETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:IL
Mailing Address - Zip Code:61353-0553
Mailing Address - Country:US
Mailing Address - Phone:520-730-7763
Mailing Address - Fax:
Practice Address - Street 1:335 FLAGG ST
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:IL
Practice Address - Zip Code:61353-8908
Practice Address - Country:US
Practice Address - Phone:520-730-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.014105104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker