Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2007036382 | MO |
Y | 103TC0700X | Clinical Psychologist | 2007036382 | MO |
NPI | 1003033572 |
---|---|
Provider Name | Dr. Zoe D. Peterson |
First Address | Saint Louis, MO 63121-4400 |
Second Address | St. Louis, MO 63131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 31/07/2013 |