Provider Demographics
NPI:1942759808
Name:PETERS, JAYDE (BCBA)
Entity type:Individual
Prefix:
First Name:JAYDE
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 HAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9284
Mailing Address - Country:US
Mailing Address - Phone:810-487-5571
Mailing Address - Fax:
Practice Address - Street 1:1159 S CARNEY DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5569
Practice Address - Country:US
Practice Address - Phone:810-328-3203
Practice Address - Fax:810-328-4501
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
MI7401001883103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other