| NPI | 1699143909 |
|---|---|
| Former Name | JESSICA L PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 9310-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 129191-121) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2019-12-03 |