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Individual

JOANNE PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ED.D

Contact information

Practice address
40 BAYNARD COVE RD, HILTON HEAD ISLAND, SC 29928-4135
(815) 409-6606
(843) 363-9997
Mailing address
40 BAYNARD COVE RD, HILTON HEAD ISLAND, SC 29928-4135
(815) 409-6606
(843) 363-9997

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071005887
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0991516762
BCBS
IL
01
219043
MAGELLAN
IL
01
274154
VALUE BEHAVIORAL HEALTH
IL
Enumeration date
10/03/2006
Last updated
01/24/2017
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