Individual
PEYTON ROSE PETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Contact information
Practice address
3120 SUITE B WINDSOR COURT, ELKHART, IN 46514
(170) 085-5267
Mailing address
1320 CRIMSON LEAF DR, GOSHEN, IN 46526-6285
(574) 807-1158
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
33008990A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33008990A
LICENSE NUMBER
IN
Enumeration date
08/09/2021
Last updated
08/09/2021
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