Individual
LINDA M. PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CP
Contact information
Practice address
3445 PENROSE PL, SUITE 250, BOULDER, CO 80301-1877
(303) 449-9494
(303) 447-6453
Mailing address
1713 MAPLETON AVE, BOULDER, CO 80304-4263
(303) 449-9494
(303) 447-6453
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1220
CO
103TC0700X
Clinical Psychologist
Primary
1220
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07012206
—
CO
Enumeration date
12/11/2006
Last updated
10/30/2007
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