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NPI Code Detail

MEDICARE: ALEXA JONES PETERSON

MEDICARE: ALEXA JONES PETERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianMN

General Provider Information

NPI Number : 1528991577
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXA JONES PETERSON
Provider Business Mailing Address
First Line : 3814 CORAL BELL DR
Second Line :
City : SHAKOPEE
State : MN
Zip : 55379-5727
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10180 VIKING DR
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7207
Country : US
Telephone Number : 612-509-6680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2026
Last Update Date : 06/08/2026

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Directions to “ ALEXA JONES PETERSON ” Practice Location

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