Healthcare Provider Details

I. General information

NPI: 1891244018
Provider Name (Legal Business Name): COURTNEY M PETERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11446 VALLEY RIDGE DR
PAPILLION NE
68046-6271
US

IV. Provider business mailing address

11446 VALLEY RIDGE DR
PAPILLION NE
68046-6271
US

V. Phone/Fax

Practice location:
  • Phone: 402-916-4539
  • Fax:
Mailing address:
  • Phone: 402-916-4539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0016
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: