Individual
KATRINA LAREA PETTERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LEP 4489
Contact information
Practice address
1261 LINCOLN AVE STE 104, SAN JOSE, CA 95125-3030
(408) 439-1111
Mailing address
2893 UNION AVE, SAN JOSE, CA 95124-1435
(760) 902-8990
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
4489
CA
Other
Enumeration date
12/05/2024
Last updated
12/19/2024
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