Individual
JANE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1217 BLACKTHORN RD, LOUISVILLE, KY 40299-4685
(502) 500-2320
Mailing address
1217 BLACKTHORN RD, LOUISVILLE, KY 40299-4685
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/21/2021
Last updated
07/21/2021
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