Provider Demographics
NPI:1205712353
Name:PETERSON, EMILY ANN (MBA, MS-CMHC)
Entity type:Individual
Prefix:
First Name:EMILY ANN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MBA, MS-CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 E GREEN LAKE DR N STE 202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4818
Mailing Address - Country:US
Mailing Address - Phone:206-659-7161
Mailing Address - Fax:
Practice Address - Street 1:7900 E GREEN LAKE DR N STE 202
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4818
Practice Address - Country:US
Practice Address - Phone:206-659-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty