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General NPI Number Information
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NPI Number | 1871292268
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Entity Type | Organization
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Legal Business Name | JENNIFER L PETERSON
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 2204 PETERSEN DR NW
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City | STEWARTVILLE
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State | MN
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Zip | 55976-1680
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Country | US
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Telephone | 507-316-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 2204 PETERSEN DR NW
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City | STEWARTVILLE
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State | MN
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Zip | 55976-1680
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Country | US
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Telephone | 507-316-2001
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Fax |
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Authorized Official
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Title or Position | LICENSEDMENTAL HEALTH PROFESSIONAL
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Name | JENNIFER LYNN PETERSON
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Credential | LICSW
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Telephone | 507-316-2001
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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 |
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License Number State |
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