Healthcare Provider Details

I. General information

NPI: 1194032276
Provider Name (Legal Business Name): JULIA H PETERSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16535 W BLUEMOUND RD
BROOKFIELD WI
53005-5936
US

IV. Provider business mailing address

1557 S 82ND ST
WEST ALLIS WI
53214-4422
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-1191
  • Fax:
Mailing address:
  • Phone: 414-429-6061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5116-057
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5079-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: