Kathy Peterson

Individual provider Intellectual and/or Developmental Disabilities Residential Treatment Facility · NPI 1407601644

Kathy Peterson is an Intellectual and/or Developmental Disabilities Residential Treatment Facility in Saint Ignace, Michigan. Practices as a sole proprietor. Licensed in Michigan.

Licensed in: MI
In the registry since: 2024

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Practice location PO Box

The provider listed a PO Box rather than a street location, so this is not a walk-in address.

PO Box 307
Saint Ignace, MI 49781-0307
Phone: (906) 643-8774
Fax: (906) 984-2028

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Specialties & licences

Intellectual and/or Developmental Disabilities Residential Treatment Facility (primary)	Taxonomy 320600000X · Licence AS490300190 (MI)

Record details

NPI number	1407601644
Entity type	Individual (Type 1)
Gender	Female
Sole proprietor	Yes
NPI enumerated	April 22, 2024
Last updated in NPPES	April 22, 2024
Certification date	April 22, 2024
Mailing address	N881 Gros Cap Rd, Saint Ignace, MI 49781-9837