Provider Demographics
NPI:1952385569
Name:PETTERSEN, BARBARA J (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:J
Last Name:PETTERSEN
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 NW POLARSTAR AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8660
Mailing Address - Country:US
Mailing Address - Phone:541-419-0097
Mailing Address - Fax:541-382-6362
Practice Address - Street 1:2607 NW POLARSTAR AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8660
Practice Address - Country:US
Practice Address - Phone:541-419-0097
Practice Address - Fax:541-382-6362
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS