Pebbles L Peterson, APSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

131777 Issued in WI

Practice address

926 Willard Dr Ste 136
Green Bay, WI 54304-5296

Phone

(920) 461-5850

NPI assigned

Jan 29, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kimberley Welk and Associates, LLC

  • Marriage & Family Therapist
  • Green Bay, WI
  • NPI 1487075214
  NPD

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

{
    "created_epoch": "1643414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643414400000",
    "number": "1700539863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926 WILLARD DR STE 136",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045296",
            "telephone_number": "920-461-5850",
            "fax_number": "888-449-6342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "926 WILLARD DR STE 136",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045296",
            "telephone_number": "920-461-5850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PEBBLES",
        "middle_name": "L",
        "credential": "APSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-29",
        "last_updated": "2022-01-29",
        "certification_date": "2022-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "131777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pebbles@kwaftc.com",
            "affiliation": "N",
            "endpointDescription": "Business email",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "pebbles@kwaftc.com",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "pebbles@kwaftc.com",
            "address_1": "926 Willard Dr Ste 136",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543045296",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brett Mychael Peterson, CRNA
• Carol Jean Peterson, APNP
• Jesse Frederick Peterson, PSYD
• Kristy A Peterson, CST
• Margaret Mary Peterson, OT
• Stephanie Marie Peterson, RN, BSN
• Tara Peterson, APNP
• Rylee M Petit, OT
• Alisha Petrouske
• Eilis Petzke

• Social Worker in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2022; 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.