Individual
LISA S PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
2623 12TH AVE, FOREST GROVE, OR 97116-3003
(503) 901-6953
Mailing address
2623 12TH AVE, FOREST GROVE, OR 97116-3003
(503) 901-6953
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
MT-T-10174257
OR
Other
Enumeration date
07/29/2024
Last updated
07/29/2024
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