Individual
JEFFREY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11905 BOWMAN DR STE 507, FREDERICKSBURG, VA 22408-7344
(339) 223-7371
Mailing address
11905 BOWMAN DR STE 507, FREDERICKSBURG, VA 22408-7344
(339) 223-7371
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
N/A
—
Enumeration date
07/26/2022
Last updated
07/26/2022
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