| NPI | 1194269837 |
|---|---|
| Former Name | JENNA PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.009758) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP6083) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2024-06-11 |