Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 166069 | KY |
N | 103T00000X | Psychologist | 166069 | KY |
Y | 102L00000X | Psychologist | PSYPAT 00218866 | KY |
Y | 103T00000X | Psychologist | PSYPAT 00218866 | KY |
NPI | 1003282559 |
---|---|
Provider Name | Anne Taylor Peterson |
First Address | Bowling Green, KY 42103-6515 |
Second Address | Bowling Green, KY 42103-6515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2015 |
Last Update Date | 14/06/2021 |