Individual
MS. KATHLEEN PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 672-2691
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
6801085075
MI
1041C0700X
Clinical Social Worker
Primary
L7293
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680108075
MICHIGAN STATE LICENSE #
MI
Enumeration date
01/13/2007
Last updated
10/15/2019
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