Individual
JAMES MICHAEL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 WELTY AVE, ROCKFORD, IL 61107-4562
(779) 221-6395
Mailing address
405 WELTY AVE, ROCKFORD, IL 61107-4562
(779) 221-6395
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
222Q00000X
Developmental Therapist
—
—
Other
Enumeration date
12/16/2024
Last updated
12/16/2024
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