Individual
LISA MARIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
215 S MAIN ST, MEMPHIS, MO 63555-1425
(660) 465-7790
Mailing address
7816 NW MILREY DR, KANSAS CITY, MO 64152-2141
(816) 507-1981
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2008032217
MO
Other
Enumeration date
04/06/2009
Last updated
04/06/2009
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