Individual
KATHY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
PO BOX 307, SAINT IGNACE, MI 49781-0307
(906) 643-8774
(906) 984-2028
Mailing address
N881 GROS CAP RD, SAINT IGNACE, MI 49781-9837
(906) 643-8774
(906) 984-2028
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
AS490300190
MI
Other
Enumeration date
04/22/2024
Last updated
04/22/2024
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