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NPI Code Detail

MEDICARE: JAIMI L PETERSON MA

MEDICARE:   JAIMI L PETERSON  MA
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
1101YM0800XMental Health CounselorC7468OR

General Provider Information

NPI Number : 1821645227
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIMI L PETERSON MA
Provider Business Mailing Address
First Line : PO BOX 521
Second Line :
City : SWEET HOME
State : OR
Zip : 97386-0521
Country : US
Telephone Number : 541-801-7596
Fax Number :
Provider Business Practice Location Address
First Line : 1266 44TH AVE
Second Line :
City : SWEET HOME
State : OR
Zip : 97386-1235
Country : US
Telephone Number : 541-801-7596
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2019
Last Update Date : 08/31/2023

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Directions to “ JAIMI L PETERSON MA” Practice Location

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