Active NPI
Jordan Peterson
- School Psychologist
- Page, AZ
National Provider Identifier
1851847578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 4109734
- Practice address
- 500 South Navajo Drive
Page, AZ 86040 - Phone
- (928) 608-4100
- NPI assigned
- Sep 1, 2016
- Last updated
- Sep 1, 2016
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 4109734 | AZ | Primary |
Addresses
Primary practice location
500 South Navajo Drive
Page, AZ 86040
Mailing address
PO Box 1927
Page, AZ 86040-1927
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 |
|---|---|---|---|
| 4109734 | AZ | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Page Unified School District #8 | Past | Accepting new patients | |
| Page Unified School District | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Local Education Agency (LEA)
- Page, AZ
- NPI 1841480886
-
- Speech-Language Assistant
- Page, AZ
- NPI 1336525948
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472688000000",
"number": "1851847578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1927",
"city": "PAGE",
"state": "AZ",
"postal_code": "860401927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 SOUTH NAVAJO DRIVE",
"city": "PAGE",
"state": "AZ",
"postal_code": "86040",
"telephone_number": "928-608-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-01",
"last_updated": "2016-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "AZ",
"license": "4109734",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Page, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.