Healthcare Provider Details

I. General information

NPI: 1336072511
Provider Name (Legal Business Name): GRACE ANN PETERSON M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S MILLER ST
SANTA MARIA CA
93454-6230
US

IV. Provider business mailing address

1504 ATLANTIC CITY AVE APT C
GROVER BEACH CA
93433-1467
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-1783
  • Fax:
Mailing address:
  • Phone: 559-314-5177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: