Active NPI
Janette Susan Peterson
- School Psychologist
- Leadore, ID
National Provider Identifier
1407433006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 0000641145
- Practice address
- 27 Harvey LN
Leadore, ID 83464-5035 - Phone
- (208) 303-0307
- NPI assigned
- Mar 28, 2021
- Last updated
- Mar 28, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 0000641145 | TN | Primary |
Addresses
Primary practice location
27 Harvey LN
Leadore, ID 83464-5035
Mailing address
PO Box 58
Leadore, ID 83464-0058
Phone (208) 303-0307
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000641145 | TN | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616889600000",
"number": "1407433006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 58",
"city": "LEADORE",
"state": "ID",
"postal_code": "834640058",
"telephone_number": "208-303-0307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27 HARVEY LN",
"city": "LEADORE",
"state": "ID",
"postal_code": "834645035",
"telephone_number": "208-303-0307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JANETTE",
"middle_name": "SUSAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-28",
"last_updated": "2021-03-28",
"certification_date": "2021-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "TN",
"license": "0000641145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leadore, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.