Individual
KAILEY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, CAPSW, SAC-IT
Contact information
Practice address
1409 EMIL ST, MADISON, WI 53713-2311
(608) 421-3406
(608) 283-6374
Mailing address
1409 EMIL ST, MADISON, WI 53713-2311
(608) 421-3406
(608) 283-6374
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
19452-130
WI
104100000X
Social Worker
Primary
132464-121
WI
Other
Enumeration date
02/10/2022
Last updated
02/10/2022
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