Peterson, Polly Wietzke
Peterson, Polly Wietzke is an sole proprietor health care provider with primary practice located at 1543 Kingsley Ave Ste 14 , Orange Park FL 32073-4570. She recently has only one registered license in Behavioral Health & Social Service Providers / School, which is considered as her primary health care specialty. Peterson, Polly Wietzke can be contacted via phone (904) 742-8164.Contact Information
Primary practice address
1543 Kingsley Ave Ste 14
Orange Park FL 32073-4570
Phone: (904) 742-8164
Fax: (904) 217-7222
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / School | 103TS0200X | SS495 | Florida |
Profile Details
| NPI number | 1902929698 |
|---|---|
| LBN Legal business name | Peterson, Polly Wietzke |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 9th, 2007 |
| Last updated | Mar 12th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902929698 | NPPES |
| Florida | Other | Z0537 | BLUE CROSS BLUE SHIELD FL |
| Florida | Other | 346340500 | BLUE CROSS BLUE SHIELD FL |
| Florida | Other | Z8341 | BLUE CROSS BLUE SHIELD FL |
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