Individual
JACQUALINE R PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUDPT
Contact information
Practice address
1601 E FOURTH PLAIN BLVD BLDG 17, VANCOUVER, WA 98661-3717
(360) 397-8246
Mailing address
206 NE 126TH AVE APT J115, VANCOUVER, WA 98684-0866
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
WA
Other
Enumeration date
03/31/2026
Last updated
04/08/2026
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