Individual
DR. CAROLYN ALISA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4039 N MISSISSIPPI AVE STE 307, PORTLAND, OR 97227-1477
(971) 402-9705
Mailing address
4039 N MISSISSIPPI AVE STE 307, PORTLAND, OR 97227-1477
(971) 402-9705
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3197
OR
Other
Enumeration date
03/18/2024
Last updated
01/25/2025
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