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NPI Code Detail

MEDICARE: DR. JEN PETERS PLLC

MEDICARE: DR. JEN PETERS PLLC
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
1261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1548087778
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. JEN PETERS PLLC
Provider Business Mailing Address
First Line : 530 CANDLEWICK CT
Second Line :
City : DUBUQUE
State : IA
Zip : 52003-8589
Country : US
Telephone Number : 563-590-7009
Fax Number :
Provider Business Practice Location Address
First Line : 880 LOCUST ST STE 129
Second Line :
City : DUBUQUE
State : IA
Zip : 52001-6700
Country : US
Telephone Number : 563-590-7009
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JENNIFER PETERS
Credential :
Telephone Number : 563-590-7009
Provider Enumeration Date : 09/19/2024
Last Update Date : 09/19/2024

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