Individual
MR. JOHN H. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
1478 KENWOOD CTR, SUITE #1, MENASHA, WI 54952-1161
(920) 886-9319
(920) 886-9357
Mailing address
1478 KENWOOD CTR, SUITE #1, MENASHA, WI 54952-1161
(920) 886-9319
(920) 886-9357
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
128-124
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39274100
—
WI
Enumeration date
07/13/2006
Last updated
07/08/2007
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