Doctor Name: | MRS. JANELLE ELISE PETERSON |
NPI Number: | 1023269057 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | L4742 |
Business Practice Address: | 913 Nw Garden Valley Blvd Roseburg, OR - 974716523 |
Business Phone Number: | 5414401000 |
Business Fax Number: | 5414401356 |
Mailing Address: | 913 Nw Garden Valley Blvd, ROSEBURG |
State: | OR |
Postal Code: | 974716523 |
Phone Number: | 5414401000 |
Fax Number: | 5414401356 |
NPI Enumeration Date: | 10/08/2008 |
NPI Last Update Date: | 04/12/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | L4742 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |