Healthcare Provider Details

I. General information

NPI: 1356543847
Provider Name (Legal Business Name): LINDA A. PETERS MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10219 KIMBERLY DR
PLAIN CITY OH
43064-8732
US

IV. Provider business mailing address

10219 KIMBERLY DR
PLAIN CITY OH
43064-8732
US

V. Phone/Fax

Practice location:
  • Phone: 614-873-3570
  • Fax:
Mailing address:
  • Phone: 614-873-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI4858
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: