Mary Jane Peterson, PHD

Primary specialty

Health & Wellness CoachTaxonomy code 171400000X

Practice address

19742 Olmstead Rd NE
Aurora, OR 97002-8712

Phone

(503) 678-2338

NPI assigned

Nov 4, 2021

Last updated

Nov 4, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1104581115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19742 OLMSTEAD RD NE",
            "city": "AURORA",
            "state": "OR",
            "postal_code": "970028712",
            "telephone_number": "503-678-2338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19742 OLMSTEAD RD NE",
            "city": "AURORA",
            "state": "OR",
            "postal_code": "970028712",
            "telephone_number": "503-678-2338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARY",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-04",
        "last_updated": "2021-11-04",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Kristin Kopshy, MM, MT-BC
• Jacob B Korolak
• Life Flight Network LLC
• Monica Rudestam
• Daniel James Keegan O'Connell, LCSW
• Monica Rudestam, LAC
• Robin Schaefer, D.C., L.AC.
• Kay Lynette Stradinger, PSYD
• Marilee J Sullivan, RDH/EPDH
• Therapeutic Associates Inc (TAI - Woodburn Physical Therapy)

• Health & Wellness Coach in Aurora, OR
• Providers in Aurora, OR by specialty
• Health & Wellness Coach in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.