Individual
JORDAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 SOUTH NAVAJO DRIVE, PAGE, AZ 86040
(928) 608-4100
Mailing address
PO BOX 1927, PAGE, AZ 86040-1927
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
4109734
AZ
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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