Individual
AMY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-IT
Contact information
Practice address
6233 DURAND AVE STE F, MOUNT PLEASANT, WI 53406-4961
(262) 554-8165
Mailing address
6905 BOBOLINK RD, RACINE, WI 53402-1344
(262) 221-7200
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4510226
WI
Other
Enumeration date
12/08/2019
Last updated
12/08/2019
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