Healthcare Provider Details

I. General information

NPI: 1992591614
Provider Name (Legal Business Name): EMMA KATE PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 LAKE ST
OAK PARK IL
60302-2606
US

IV. Provider business mailing address

808 S BELL AVE APT 2
CHICAGO IL
60612-3545
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-0113
  • Fax:
Mailing address:
  • Phone: 715-218-5837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: