Individual
MS. JANE M PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6502 GRAND TETON PLAZA, SUITE 203, MADISON, WI 53719-1047
(608) 827-7220
(608) 827-7223
Mailing address
5 HAVERHILL CIRCLE, MADISON, WI 53717-1026
(608) 836-0611
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39668600
—
WI
Enumeration date
10/04/2006
Last updated
07/08/2007
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