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General NPI Number Information
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NPI Number | 1346269032
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Entity Type | Individual
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Provider Name | DONNA SUE PETERSON PSY.D, LP
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 13045 FALCON DR SUITE 100
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City | BAXTER
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State | MN
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Zip | 56425-4201
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Country | US
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Telephone | 218-829-9307
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Fax | 218-829-7649
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Provider Business Mailing Address
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Address Line | PO BOX 1050
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City | CROSSLAKE
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State | MN
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Zip | 56442-1050
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Country | US
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Telephone | 763-226-1954
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP2983
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License Number State | MN
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