Provider Demographics
NPI:1891512604
Name:PETERMAN, MEREDITH JOYCE
Entity type:Individual
Prefix:MISS
First Name:MEREDITH
Middle Name:JOYCE
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24700 E BUNDSCHU RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64056-3940
Mailing Address - Country:US
Mailing Address - Phone:816-284-6056
Mailing Address - Fax:
Practice Address - Street 1:19201 E VALLEY VIEW PKWY STE H
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6913
Practice Address - Country:US
Practice Address - Phone:816-474-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician