Provider Demographics
NPI:1710609672
Name:PEATEE, JESSICA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:J
Last Name:PEATEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 GRAND RIVER ANX STE 300
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-5313
Mailing Address - Country:US
Mailing Address - Phone:810-224-1676
Mailing Address - Fax:
Practice Address - Street 1:2040 GRAND RIVER ANX STE 300
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-5313
Practice Address - Country:US
Practice Address - Phone:810-224-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351004497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical