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General NPI Number Information
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NPI Number | 1659603686
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Entity Type | Individual
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Provider Name | ROXANNE S PETERSON
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Gender | Female
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Dates
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Enumeration Date | 02/01/2010
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 615 SHORT ST
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City | STEILACOOM
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State | WA
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Zip | 98388-3115
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Country | US
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Telephone | 253-221-6789
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Fax | 253-584-8046
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Provider Business Mailing Address
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Address Line | 615 SHORT ST
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City | STEILACOOM
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State | WA
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Zip | 98388-3115
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Country | US
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Telephone | 253-221-6789
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN00063729
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License Number State | WA
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