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NPI Code Detail

MEDICARE: TAMATHA SHON PETERSON

MEDICARE: TAMATHA SHON PETERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCS24142CA

General Provider Information

NPI Number : 1033241898
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMATHA SHON PETERSON
Provider Business Mailing Address
First Line : 11716 ENTERPRISE DR
Second Line :
City : AUBURN
State : CA
Zip : 95603-3732
Country : US
Telephone Number : 530-889-6743
Fax Number :
Provider Business Practice Location Address
First Line : 11716 ENTERPRISE DR
Second Line :
City : AUBURN
State : CA
Zip : 95603-3732
Country : US
Telephone Number : 530-889-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 01/03/2022

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Directions to “ TAMATHA SHON PETERSON ” Practice Location

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