Healthcare Provider Details

I. General information

NPI: 1851085641
Provider Name (Legal Business Name): CAILEIGH PETERS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 INWOOD AVE N
OAKDALE MN
55128-6625
US

IV. Provider business mailing address

19430 ORWELL CT N
MARINE ON SAINT CROIX MN
55047-9776
US

V. Phone/Fax

Practice location:
  • Phone: 843-422-7417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP6939
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP6939
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: