Kathy Peterson
Individual provider Active NPI Intellectual and/or Developmental Disabilities Residential Treatment Facility · Saint Ignace, MI
NPI 1407601644 · NPPES record last updated Apr 22, 2024
Key facts
- NPI
- 1407601644
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
- License
- AS490300190 (MI)
- Practice address
- PO Box 307
Saint Ignace, MI 49781-0307 - Phone
- (906) 643-8774
- Fax
- (906) 984-2028
- NPI assigned
- Apr 22, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AS490300190 | MI | MD | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | AS490300190 | MI | Yes |
Addresses
Primary practice location
PO Box 307
Saint Ignace, MI 49781-0307
Mailing address
N881 Gros Cap Rd
Saint Ignace, MI 49781-9837
Phone (906) 643-8774
Other providers in Saint Ignace, MI
- Donna Marie Nye I
- Beverly S. Osborne
- Brent Richard Paape
- Dana Marjorie Paape
- Christina Dawn Perlberg
- Pickford Medical Center
- Daniel Gage Postma
- Rachel Rife
- Sacred Heart Rehabilitation Center, Inc
- Gwendolyn Kay Sangeorzan
All providers in Saint Ignace, MI · Intellectual and/or Developmental Disabilities Residential Treatment Facility in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.