Provider Demographics
NPI:1629612262
Name:PETERSON, BETH (BA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 E HOQUIAM RD
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-9115
Mailing Address - Country:US
Mailing Address - Phone:360-581-9323
Mailing Address - Fax:
Practice Address - Street 1:3033 INGRAM ST STE 3033-B
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-4410
Practice Address - Country:US
Practice Address - Phone:360-581-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist