MEDICARE: ROBERT JOHN PETERSON LICSW

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	1041C0700X	Clinical Social Worker	60174553	WA
2	104100000X	Social Worker	X-06759	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	336712	OTHER	NM	PED LICENSE
2	X-06759	OTHER	NM	STATE LICENSE

General Provider Information

NPI Number	:	1922336684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JOHN PETERSON LICSW

Provider Business Mailing Address
First Line	:	40647 LAKE RD
Second Line	:
City	:	LOON LAKE
State	:	WA
Zip	:	99148-9795
Country	:	US
Telephone Number	:	99-395-5155
Fax Number	:

Provider Business Practice Location Address
First Line	:	40647 LAKE RD
Second Line	:
City	:	LOON LAKE
State	:	WA
Zip	:	99148-9795
Country	:	US
Telephone Number	:	509-939-5515
Fax Number	:

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

Provider Enumeration Date	:	11/18/2009
Last Update Date	:	11/09/2023

Similar Medicare Providers

1295799195 — NEW HEALTH PROGRAMS ASSOCIATION
Practice Location Address:

3994 COLVILLE RD
LOON LAKE, WA
99148-9789

Practice Phone: 509-233-8412
Practice Fax: 509-233-2864

1124051347 — LOON LAKE SCHOOL DISTRICT #183
Practice Location Address:

4001 MAPLE ST
LOON LAKE, WA
99148-9761

Practice Phone: 509-233-2212
Practice Fax: 509-233-2537

1912008988 — MRS. MELINDA CECILE EKHOLM ARNP
Practice Location Address:

3994 COLVILLE RD
LOON LAKE, WA
99148-9789

Practice Phone: 509-233-8412
Practice Fax: 509-233-2864

1780836981 — BRENDA MICHELE HUGHBANKS MA 60040625
Practice Location Address:

4130 A GARDEN SPOT RD.
LOON LAKE, WA
99148

Practice Phone: 509-233-8660
Practice Fax:

1992940803 — PAUL FREDERIC DAVIS D.D.S.
Practice Location Address:

40217 NORTH SHORE DR.
LOON LAKE, WA
99148-0765

Practice Phone: 509-233-9074
Practice Fax:

1821654930 — NAOMI CARRASCO
Practice Location Address:

3941B HIGHWAY 292
LOON LAKE, WA
99148-9790

Practice Phone: 509-991-0290
Practice Fax:

Directions to “ ROBERT JOHN PETERSON LICSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.