MEDICARE: ANNIKA PETERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	19277	MN

General Provider Information

NPI Number	:	1427660711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIKA PETERSON

Provider Business Mailing Address
First Line	:	2632 5TH AVE NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-2363
Country	:	US
Telephone Number	:	507-272-0930
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 5TH AVE NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-2363
Country	:	US
Telephone Number	:	507-272-0930
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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Directions to “ ANNIKA PETERSON ” Practice Location

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