Individual
DR. SHELLY LYNNE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
11100 ASH ST STE 100, LEAWOOD, KS 66211-1700
(913) 735-9007
Mailing address
11100 ASH ST STE 100, LEAWOOD, KS 66211-1700
(913) 735-9007
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2112
KS
103TC0700X
Clinical Psychologist
TLP-2112
KS
Other
Enumeration date
10/26/2012
Last updated
03/16/2019
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