Individual
JESSE FREDERICK PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
301 E SAINT JOSEPH ST, GREEN BAY, WI 54301-2241
(920) 433-6073
(920) 431-0333
Mailing address
PO BOX 22040, GREEN BAY, WI 54305-2040
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3690-57
WI
Other
Enumeration date
11/08/2019
Last updated
11/11/2019
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