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General NPI Number Information
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NPI Number | 1144992520
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Entity Type | Individual
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Provider Name | JENNIFER R PETERSEN LPCC
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Gender | Female
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/19/2025
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Provider Practice Location Address
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Address Line | 230 KNOX ST S
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City | ALPHA
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State | MN
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Zip | 56111-4006
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Country | US
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Telephone | 507-407-9775
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Fax |
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Provider Business Mailing Address
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Address Line | 125 S LINDBERG AVE
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City | DUNNELL
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State | MN
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Zip | 56127-4006
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Country | US
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Telephone | 612-968-4725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 21522
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4424
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License Number State | MN
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