| Christine Irene Peterson, Llc | |
|
209 E Washington Ave Ste 210 Jackson MI 49201-2393 | |
| (517) 262-9178 | |
| (517) 748-7188 |
| Full Name | Christine Irene Peterson, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 209 E Washington Ave Ste 210, Jackson, Michigan |
| Authorized Official Name and Position | Christine Irene Peterson (OWNER) |
| Authorized Official Contact | 5172629178 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Christine Irene Peterson, Llc 209 E Washington Ave Ste 210 Jackson MI 49201-2393 Ph: (517) 262-9178 | Christine Irene Peterson, Llc 209 E Washington Ave Ste 210 Jackson MI 49201-2393 Ph: (517) 262-9178 |
| NPI Number | 1851179089 |
|---|---|
| Provider Enumeration Date | 09/19/2023 |
| Last Update Date | 09/19/2023 |
| Certification Date | 09/19/2023 |
| Medicare PECOS PAC ID | 9133573595 |
|---|---|
| Medicare Enrollment ID | O20231004000200 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851179089 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Christine Irene Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225703242 PECOS PAC ID: 7911304605 Enrollment ID: I20231004000254 |
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