Individual
KRISTINA PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2580 HWAY 95 # 1250, BULLHEAD CITY, AZ 86442-7491
(928) 763-7776
(928) 763-7786
Mailing address
3450 N 3RD ST, PHOENIX, AZ 85012-2331
(602) 257-9339
(602) 265-8533
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13439
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AZ
Enumeration date
10/08/2014
Last updated
10/08/2014
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