| Doctor Name: | DR. GAIL PETERSON |
| NPI Number: | 1629058904 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 2006006592 |
| Business Practice Address: | 1400 N Wood Rd Milwood Executive Suites Murphysboro, IL - 629666290 |
| Business Phone Number: | 6185294988 |
| Business Fax Number: | 6183511419 |
| Mailing Address: | Po Box 443, CARBONDALE |
| State: | IL |
| Postal Code: | 629030443 |
| Phone Number: | 6185294988 |
| Fax Number: | 6183511419 |
| NPI Enumeration Date: | 01/20/2006 |
| NPI Last Update Date: | 07/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | 2006006592 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |