Provider Demographics
NPI:1679658355
Name:PETERSON, PEGGY ANN (MA)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 MANSFIELD ST STE 5
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3588
Mailing Address - Country:US
Mailing Address - Phone:509-943-0990
Mailing Address - Fax:509-943-0040
Practice Address - Street 1:1305 MANSFIELD ST STE 5
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3588
Practice Address - Country:US
Practice Address - Phone:509-943-0990
Practice Address - Fax:509-943-0040
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60014855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health