Healthcare Provider Details

I. General information

NPI: 1467279836
Provider Name (Legal Business Name): ALLY PETERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 MEANDER CT
HAMEL MN
55340-4549
US

IV. Provider business mailing address

735 LYNN RD SW
HUTCHINSON MN
55350-2838
US

V. Phone/Fax

Practice location:
  • Phone: 952-999-6097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: