| NPI | 1306093539 |
|---|---|
| Former Name | JACLYN A PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 4440-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 14731-130) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15416-132) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2016-03-16 |