Individual
JANETTE SUSAN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
27 HARVEY LN, LEADORE, ID 83464-5035
(208) 303-0307
Mailing address
PO BOX 58, LEADORE, ID 83464-0058
(208) 303-0307
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
0000641145
TN
Other
Enumeration date
03/28/2021
Last updated
03/28/2021
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