Provider Demographics
NPI:1164249538
Name:PETERS, CORINNE
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W836 LAKE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520-9659
Mailing Address - Country:US
Mailing Address - Phone:608-931-4923
Mailing Address - Fax:
Practice Address - Street 1:W836 LAKE VIEW CIR
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-9659
Practice Address - Country:US
Practice Address - Phone:608-931-4923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional