Individual
JESSICA RAELYNN PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
27121 174TH PL SE STE 105, COVINGTON, WA 98042-4939
(425) 399-3245
Mailing address
28682 SE 424TH ST, ENUMCLAW, WA 98022-9786
(253) 293-6405
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/06/2023
Last updated
02/06/2023
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