Individual
JEREMY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1412 140TH PL NE, BELLEVUE, WA 98007-3915
(425) 747-7892
Mailing address
201 UNION AVE SE UNIT 204, RENTON, WA 98059-5182
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/04/2016
Last updated
10/04/2016
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