Healthcare Provider Details

I. General information

NPI: 1003826959
Provider Name (Legal Business Name): ANGELA ARDIS PETERS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 4TH ST. SUITE 303
SIOUX CITY IA
51101
US

IV. Provider business mailing address

600 4TH ST. SUITE 303
SIOUX CITY IA
51101
US

V. Phone/Fax

Practice location:
  • Phone: 712-222-1432
  • Fax: 712-222-1433
Mailing address:
  • Phone: 712-574-9220
  • Fax: 712-222-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01004
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: