Provider Demographics
NPI:1851154900
Name:PETERSON, ROBERT ANTON
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTON
Last Name:PETERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 KENDALL AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53726-3980
Mailing Address - Country:US
Mailing Address - Phone:262-221-4626
Mailing Address - Fax:
Practice Address - Street 1:5005 UNIVERSITY AVE STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-5400
Practice Address - Country:US
Practice Address - Phone:608-233-2100
Practice Address - Fax:608-233-2101
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20207-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)