Individual
DR. GAIL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1400 N WOOD RD, MILWOOD EXECUTIVE SUITES, MURPHYSBORO, IL 62966-6290
(618) 529-4988
(618) 351-1419
Mailing address
PO BOX 443, CARBONDALE, IL 62903-0443
(618) 529-4988
(618) 351-1419
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
071-002561
IL
103TB0200X
Cognitive & Behavioral Psychologist
2006006592
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03972011
BLUE CROSS/ BLUE SHIELD
IL
01
—
126480
HEALTHLINK PROVIDER #
IL
01
—
27485
HEALTH ALLIANCE MEDICAL PLANS
IL
Enumeration date
01/20/2006
Last updated
07/03/2013
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