Individual
MR. MAGNUM PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EDS
Contact information
Practice address
607 E OAK ST, RED OAK, IA 51566-1642
(336) 739-0069
Mailing address
607 E OAK ST, RED OAK, IA 51566-1642
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1196254
NC
Other
Enumeration date
09/29/2022
Last updated
09/29/2022
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