Individual
CHARLOTTE L PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2016 S WASHINGTON ST, GRAND FORKS, ND 58201-6342
(701) 757-4200
Mailing address
2205 5TH AVE N, GRAND FORKS, ND 58203-2924
(847) 989-8568
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-39667
—
Other
Enumeration date
08/07/2017
Last updated
08/29/2017
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