Individual
CORENE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1565 E LINCOLN RD, IDAHO FALLS, ID 83401-2129
(208) 524-8996
(208) 524-1205
Mailing address
1565 E LINCOLN RD, IDAHO FALLS, ID 83401-2129
(208) 524-8996
(208) 524-1205
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-34038
ID
Other
Enumeration date
02/08/2012
Last updated
10/10/2014
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