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NPI Code Detail

MEDICARE: SKY M PETERSEN

MEDICARE: SKY M PETERSEN
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
1106S00000XBehavior Technician
2103K00000XBehavior AnalystMN

General Provider Information

NPI Number : 1821662214
Entity Type Code : Individual
Provider Name (Legal Business Name) : SKY M PETERSEN
Provider Business Mailing Address
First Line : 14301 EWING AVE S
Second Line :
City : BURNSVILLE
State : MN
Zip : 55306-4885
Country : US
Telephone Number : 952-746-5365
Fax Number :
Provider Business Practice Location Address
First Line : 4255 LEXINGTON AVE N
Second Line :
City : ARDEN HILLS
State : MN
Zip : 55126-6164
Country : US
Telephone Number : 952-746-5350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2021
Last Update Date : 03/06/2026

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Directions to “ SKY M PETERSEN ” Practice Location

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