MEDICARE: MARGARET ROSE PETERSEN MA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1457984684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET ROSE PETERSEN MA

Provider Business Mailing Address
First Line	:	7401 BRISTOL VILLAGE DR
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55438-2561
Country	:	US
Telephone Number	:	763-477-1318
Fax Number	:

Provider Business Practice Location Address
First Line	:	7801 E BUSH LAKE RD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55439-3120
Country	:	US
Telephone Number	:	763-477-1318
Fax Number	:

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

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	07/21/2023

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