Individual
MR. JACOB M PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
300 RIP VAN WINKLE DR, WAUKESHA, WI 53186-3057
(262) 278-0044
Mailing address
300 RIP VAN WINKLE DR, WAUKESHA, WI 53186-3057
(262) 278-0044
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
05/05/2026
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