Provider Demographics
NPI:1598413544
Name:PETERSEN, LAURA ASHLEY (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ASHLEY
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 SODA LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-6317
Mailing Address - Country:US
Mailing Address - Phone:775-297-6482
Mailing Address - Fax:775-431-2992
Practice Address - Street 1:2277 SODA LAKE RD
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-6317
Practice Address - Country:US
Practice Address - Phone:775-297-6482
Practice Address - Fax:775-431-2992
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst