Healthcare Provider Details

I. General information

NPI: 1538188214
Provider Name (Legal Business Name): STEPHANIE A PETERSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11319 P ST SUITE ONE
OMAHA NE
68137-6302
US

IV. Provider business mailing address

11319 P ST SUITE ONE
OMAHA NE
68137-6302
US

V. Phone/Fax

Practice location:
  • Phone: 402-592-0328
  • Fax: 402-592-4170
Mailing address:
  • Phone: 402-592-0328
  • Fax: 402-592-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number506
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number506
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: