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General NPI Number Information
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NPI Number | 1265746242
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Entity Type | Individual
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Provider Name | COURTNEY L PETERSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 325 N COMMERCIAL ST
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City | NEENAH
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State | WI
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Zip | 54956-2665
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Country | US
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Telephone | 920-725-1230
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Fax |
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Provider Business Mailing Address
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Address Line | N984 ALEXANDRA WAY
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City | GREENVILLE
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State | WI
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Zip | 54942-2304
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Country | US
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Telephone | 920-770-2090
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7607-M
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8793-123
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License Number State | WI
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