Healthcare Provider Details

I. General information

NPI: 1023937257
Provider Name (Legal Business Name): AUDREY PETERSON ALMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E CHURCH ST
SANDWICH IL
60548-9803
US

IV. Provider business mailing address

1120 E MAIN ST
ST CHARLES IL
60174-2287
US

V. Phone/Fax

Practice location:
  • Phone: 815-786-8606
  • Fax: 815-786-1541
Mailing address:
  • Phone: 630-377-6613
  • Fax: 630-377-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number208011674
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: