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General NPI Number Information
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NPI Number | 1346792256
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Entity Type | Individual
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Provider Name | DONNA PETERSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 1500 14TH ST SW SUITE 250
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City | WILLISTON
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State | ND
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Zip | 58801
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Country | US
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Telephone | 701-334-6242
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 96
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City | RAY
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State | ND
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Zip | 58849-0096
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Country | US
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Telephone | 701-568-3385
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5339
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 082344
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License Number State | NY
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