Individual
JOLENE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW PIP
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2215
(605) 355-2504
Mailing address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2215
(605) 355-2504
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1265
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
554090
—
SD
Enumeration date
04/13/2006
Last updated
04/11/2022
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