NPPES file of Aug 9, 2026

Polly Wietzke Peterson, PH.D.

School Psychologist · Orange Park, FL

Polly Wietzke Peterson, PH.D. is a school psychologist with a practice address in Orange Park, Florida, and NPI 1902929698, issued on Apr 9, 2007. Check the license (Florida SS495, as entered in NPPES) on the Florida health license search; the federal record below is the public data PlainDoctor holds for this provider.

Record from CMS NPPES, file of Aug 9, 2026 · method · Verify with CMS →

NPPES recordNPPES file of Aug 9, 2026
1902929698
Name
Polly Wietzke Peterson
Credential
PH.D.
Primary taxonomy
School Psychologist 103TS0200X
License number
SS495 FL
Self-reported in NPPES; status is on the state search
Practice location
1543 Kingsley Ave Ste 14, Orange Park, FL 32073
Phone
(904) 742-8164
Enumerated
Apr 9, 2007
Record last updated
Mar 12, 2021 (not updated in 5 years: call before relying on the address or phone)
Fax
(904) 217-7222
Medicare enrollment
Enrolled (PECOS I20200615002521); accepts Medicare assignment
Telehealth
Offers telehealth (CMS)
Entity
Type 1 · individual
Public record from CMS NPPES (open it on the CMS NPI Registry). Enrollment, assignment, school and telehealth: CMS Doctors and Clinicians file, Aug 2026. A record is not a license: verify it with the state board.
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8 nearest school psychologist records → All 497 in Florida → Look up another NPI →

Also registered at 1543 Kingsley Ave Ste 14

A shared address usually means a shared clinic or building; it does not show who employs whom.

  1. Katherine Black, LCSWClinical Social Worker1700342540
  2. Suhas Joshi, M.D.Psychiatry Physician1194747485
  3. Ubaid Khokhar, MDPsychiatry Physician1275713935
  4. Eliot Kohn, LMHCMental Health Counselor1194201939
  5. Zachary Larson, LMHCMental Health Counselor1235895343
  6. Sarah Lynch, APRNPsychiatric/Mental Health Nurse Practitioner1669013595

Verify Polly Wietzke Peterson in five checks

  1. 1IdentityNPI record in CMS NPPESNPI lookupConfirmed in NPPES
  2. 2LicenseActive license and public ordersFlorida health license search
    Search for license SS495    Check the board
  3. 3Other statesLicenses and actions elsewhereDocInfo (FSMB)Not checked
  4. 4ExclusionsMedicare and Medicaid bansHHS-OIG exclusion listNot checked
  5. 5CertificationBoard certificationABMS AOA NCCPA AANPNot checked
Open the Florida license search

PlainDoctor does not match the HHS-OIG exclusion list to individual records: most entries carry no NPI. Search the OIG exclusion list by name.

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Polly Wietzke Peterson among 497 school psychologist records in Florida

Polly Wietzke Peterson, PH.D. is one of 497 school psychologist records with a practice address in Florida. under 1% of them appear in a Medicare file (Part D prescribing, MIPS, Open Payments or Medicare group billing); this one does not. Its NPI, issued in 2007, is newer than 3% of them.

  • NPI issued2007 · 3% of these records are older, 93% newer
  • In a Medicare fileNo · under 1% of these records are
  • In the CMS Doctors and Clinicians fileYes · 2% of these records are
  • Record last updated2021 · 49% of these records were not updated in five years or more

Source: CMS NPPES, file of Aug 9, 2026, every record with primary taxonomy 103TS0200X and a Florida practice address; Medicare files: CMS Part D Prescribers 2024, MIPS 2023, Open Payments 2024, Doctors and Clinicians (data.cms.gov).

School Psychologist providers in Florida

There are 497 school psychologist records in Florida. No Medicare prescribing, quality score, industry payment or hospital affiliation is published for this NPI.

All 497 in Florida → Every provider in Orange Park → School Psychologist nationwide →

The 8 school psychologist records with the nearest ZIP codes

  1. Anne Eno, ED.S.O Brien, FL 320711518181643
  2. Kathryn Steele, PHDSt Augustine, FL 320801316428683
  3. Marena Artz, PSYDPonte Vedra, FL 320811215744404
  4. Jenny Gamble, SSPOrange Park, FL 320651194339994
  5. Kate NelsonPonte Vedra, FL 320811124824727
  6. Alyssa Peterson, ED.S.Orange Park, FL 320651528307212
  7. Vonda Staten, PSYDOrange Park, FL 320651407619240
  8. Meghan Ambrose, MS, LSPPonte Vedra Beach, FL 320821134799471

Common questions

What is Polly Wietzke Peterson, PH.D.'s NPI number?

Polly Wietzke Peterson, PH.D.'s National Provider Identifier (NPI) is 1902929698, issued on Apr 9, 2007. An NPI identifies a provider in billing; it is not a license.

Where is Polly Wietzke Peterson, PH.D. located?

The NPPES record lists a practice address at 1543 Kingsley Ave Ste 14, Orange Park, FL, 32073. Phone: (904) 742-8164. Providers update this record themselves, so call before visiting.

How can I verify Polly Wietzke Peterson, PH.D.'s license?

NPPES lists Florida license number SS495, as entered by the provider. Search the Florida health license search at https://mqa-internet.doh.state.fl.us/mqasearchservices/healthcareproviders. The NPPES record confirms identity only; the state search shows license status, expiration and public orders.

Source: CMS National Plan and Provider Enumeration System (NPPES), file of Aug 9, 2026 (NPPES files on CMS.gov); NUCC Health Care Provider Taxonomy. An NPI identifies who bills; it is not a license.

Written with AI tools from the named public files; every figure is computed from those files (how it is made).

Figures on PlainDoctor are read from the federal files each page names (CMS NPPES, Medicare Part D, MIPS, Open Payments; the HHS-OIG exclusion list only as counts) and from Census population estimates, with the file date shown beside them. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error. Data current as of Aug 9, 2026.