Individual
DIANE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
18640 W IL ROUTE 120, GRAYSLAKE, IL 60030-9733
(847) 548-6000
(847) 548-6040
Mailing address
18640 W IL ROUTE 120, GRAYSLAKE, IL 60030-9733
(847) 548-6000
(847) 548-6040
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.005019
IL
Other
Enumeration date
03/05/2013
Last updated
03/05/2013
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