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NPI Code Detail

MEDICARE: DESIREA PETERSON

MEDICARE: DESIREA PETERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1467302802
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESIREA PETERSON
Provider Business Mailing Address
First Line : 624 MARKET AVE N
Second Line :
City : CANTON
State : OH
Zip : 44702-1017
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 624 MARKET AVE N
Second Line :
City : CANTON
State : OH
Zip : 44702-1017
Country : US
Telephone Number : 330-493-4553
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2026
Last Update Date : 02/03/2026

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Directions to “ DESIREA PETERSON ” Practice Location

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