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General NPI Number Information
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NPI Number | 1376998427
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Entity Type | Individual
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Provider Name | MRS. JAMIE LYN PETERSON
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Gender | Female
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 195 ANSELMO DR
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City | RENO
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State | NV
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Zip | 89523-8989
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Country | US
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Telephone | 775-247-7866
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Fax |
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Provider Business Mailing Address
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Address Line | 539 W TAYLOR ST
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City | RENO
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State | NV
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Zip | 89509-1921
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Country | US
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Telephone | 775-247-7866
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11895-C
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License Number State | NV
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