Individual
KINDRA DAWN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
700 WALTER STREET SP. 21, ENTERPRISE, OR 97828
(541) 398-1166
Mailing address
PO BOX 268, ENTERPRISE, OR 97828-0268
(541) 426-4524
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/03/2019
Last updated
04/03/2019
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