| NPI | 1235397381 |
|---|---|
| Former Name | BRENDA JEAN PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QD1600X Clinic/Center Developmental Disabilities (Licence: MN 830452) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2008-05-27 |