Provider Demographics
NPI:1578682332
Name:PETERSON, JOYCE SHIRLEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:SHIRLEY
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHADWICK
Mailing Address - State:IL
Mailing Address - Zip Code:61014-9361
Mailing Address - Country:US
Mailing Address - Phone:815-684-5428
Mailing Address - Fax:
Practice Address - Street 1:125 S 4TH ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1609
Practice Address - Country:US
Practice Address - Phone:815-732-3157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health