Joanne Peterson, ED.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071005887 Issued in IL

Practice address

40 Baynard Cove Rd
Hilton Head Island, SC 29928-4135

Phone

(815) 409-6606

Fax

(843) 363-9997

NPI assigned

Oct 3, 2006

Last updated

Jan 24, 2017By the provider in NPPES

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

Other identifiers 3

Other names 1

• Joanne E Hattendorf Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 22, 2022 through Jun 22, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Joanne Peterson Edd LLC

  • Psychologist
  • Hilton Head Island, SC
  • NPI 1548711641
  NPD (past) Authorized official

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485216000000",
    "number": "1750475430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 BAYNARD COVE RD",
            "city": "HILTON HEAD ISLAND",
            "state": "SC",
            "postal_code": "299284135",
            "telephone_number": "815-409-6606",
            "fax_number": "843-363-9997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 BAYNARD COVE RD",
            "city": "HILTON HEAD ISLAND",
            "state": "SC",
            "postal_code": "299284135",
            "telephone_number": "815-409-6606",
            "fax_number": "843-363-9997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JOANNE",
        "credential": "ED.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2017-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071005887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "219043",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0991516762",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE BEHAVIORAL HEALTH",
            "identifier": "274154",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOANNE",
            "last_name": "HATTENDORF",
            "middle_name": "E",
            "credential": "EDD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Judy Claire Paull, DNP, APRN
• Martin K Pauls, DDS
• Tiffany Peach, RN
• Kristin Denise Perilli, OTR/L
• Abbigail Kathleen Peters, L.AC.
• Ryan O Petrikas
• Michael Anthony Petrillo, PA
• William I Petty II, M.D.
• David Allen Phillips, MD
• Raleigh Phillips, D.C.

• Psychologist in Hilton Head Island, SC
• Providers in Hilton Head Island, SC by specialty
• Psychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.