MEDICARE: JEFFREY M PETERS LMSW

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
1	104100000X	Social Worker	LMSW 6247	KS
2	1041C0700X	Clinical Social Worker	3958	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	845536	OTHER	KS	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1043245111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY M PETERS LMSW

Provider Business Mailing Address
First Line	:	480 S ROGERS RD
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-1706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 S ROGERS RD
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-1706
Country	:	US
Telephone Number	:	913-780-3387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/25/2013

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