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Individual

MR. JACOB M PETERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MA

Contact information

Practice address
259 W BROADWAY STE 123, WAUKESHA, WI 53186-4832
(262) 278-0044
Mailing address
259 W BROADWAY STE 123, WAUKESHA, WI 53186-4832
(262) 278-0044
(262) 277-0947

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
12523-125
WI
101YP2500X
Professional Counselor
Primary
12523-125
WI
101YP2500X
Professional Counselor
Primary
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12523-125
STATE OF WI DSPS
WI
Enumeration date
09/06/2023
Last updated
05/28/2026
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