Provider Demographics
NPI:1639275415
Name:PETERSEN, DANA MICHELLE (BSW,QMHA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MICHELLE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:BSW,QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 HWY 99 NORTH
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402
Mailing Address - Country:US
Mailing Address - Phone:618-632-9060
Mailing Address - Fax:
Practice Address - Street 1:969 HWY 99 NORTH
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402
Practice Address - Country:US
Practice Address - Phone:541-689-7156
Practice Address - Fax:541-285-0045
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker