NPI Code Details Logo

NPI 1487572376

NPI 1487572376 : KAITLIN N PETERSON APSW : EAU CLAIRE, WI

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1487572376
-----------------------------------------------------
    Entity Type          |    Individual 
-----------------------------------------------------
    Provider Name        |    KAITLIN N PETERSON APSW
-----------------------------------------------------
    Gender               |    Female 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    07/08/2026
-----------------------------------------------------
    Last Update Date     |    07/10/2026
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    2925 MONDOVI RD 
-----------------------------------------------------
    City                 |    EAU CLAIRE
-----------------------------------------------------
    State                |    WI
-----------------------------------------------------
    Zip                  |    54701-6141
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    715-832-0238
-----------------------------------------------------
    Fax                  |    
-----------------------------------------------------

=====================================================
Provider Business Mailing Address
=====================================================
    Address Line         |    2925 MONDOVI RD 
-----------------------------------------------------
    City                 |    EAU CLAIRE
-----------------------------------------------------
    State                |    WI
-----------------------------------------------------
    Zip                  |    54701-6141
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    715-832-0238
-----------------------------------------------------
    Fax                  |    715-832-0771
-----------------------------------------------------

=====================================================
Authorized Official
=====================================================
    Title or Position    |    
-----------------------------------------------------
    Name                 |        
-----------------------------------------------------
    Credential           |    
-----------------------------------------------------
    Telephone            |    
-----------------------------------------------------

=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
    Taxonomy Code        |    104100000X
-----------------------------------------------------
    Taxonomy Name        |    Social Worker
-----------------------------------------------------
    License Number       |    135386-121
-----------------------------------------------------
    License Number State |    WI
-----------------------------------------------------



                        

Copyright © 2007-2026 Data Labs Health. All rights reserved.