Active NPI
Cynthia June Peterson, LISW
- Social Worker
- Pella, IA
National Provider Identifier
1114955341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 00783
- Practice address
- 2611 Washington Street
Pella, IA 50219-1257 - Phone
- (641) 628-9599
- Fax
- (641) 621-1493
- NPI assigned
- Jun 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 00783 | IA | Primary |
Addresses
Primary practice location
2611 Washington Street
Pella, IA 50219-1257
Mailing address
2611 Washington Street
Pella, IA 50219-1257
Phone (641) 628-9599
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0244590 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114955341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2611 WASHINGTON STREET",
"city": "PELLA",
"state": "IA",
"postal_code": "502191257",
"telephone_number": "641-628-9599",
"fax_number": "641-621-1493"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2611 WASHINGTON STREET",
"city": "PELLA",
"state": "IA",
"postal_code": "502191257",
"telephone_number": "641-628-9599",
"fax_number": "641-621-1493"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "CYNTHIA",
"middle_name": "JUNE",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IA",
"license": "00783",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0244590",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pella, IA
- Pella Regional Health Center
- Pella Sleep & Wellness Inc
- Taryn Pennington, ATC
- Kendra Nicole Perry, NP
- Megan Petersen, LAT, ATC
- Dianne M Pettit, DIETITIAN
- Mary Elizabeth Phillips, DIETITIAN
- Kimberly Kay Pickett, LISW
- Heather Renee Pilcher, PTA, MSE, ATC, LAT
- Pine Rest Christian Mental Health Services
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.