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General NPI Number Information
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NPI Number | 1538900725
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Entity Type | Individual
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Provider Name | MICKAELLE PETERSEN MSW, LMHP
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Gender | Female
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 4101 WOOLWORTH AVENUE 117C- DORCAS
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City | OMAHA
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State | NE
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Zip | 68105
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Country | US
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Telephone | 402-977-4467
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Fax |
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Provider Business Mailing Address
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Address Line | 2805 HUNTER DR
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City | BELLEVUE
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State | NE
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Zip | 68123-4621
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Country | US
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Telephone | 636-866-1355
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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 | 6396
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2578
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License Number State | NE
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