Healthcare Provider Details

I. General information

NPI: 1891884326
Provider Name (Legal Business Name): HIGHLAND PSYCHIATRIC SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 ST PAUL AVE
ST PAUL MN
55116
US

IV. Provider business mailing address

897 ST PAUL AVE
ST PAUL MN
55116
US

V. Phone/Fax

Practice location:
  • Phone: 651-698-4443
  • Fax: 651-698-4817
Mailing address:
  • Phone: 651-698-4443
  • Fax: 651-698-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SUZY ELLEN PETERSON
Title or Position: OWNER
Credential: DO
Phone: 651-698-4443