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NPI Code Detail

MEDICARE: SHATAWNEE PETERSON MS, PMSW, PMHP

MEDICARE: SHATAWNEE PETERSON MS, PMSW, PMHP
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
11041C0700XClinical Social Worker14171NE
2101YM0800XMental Health Counselor8119NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851058036
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHATAWNEE PETERSON MS, PMSW, PMHP
Provider Business Mailing Address
First Line : 207 GALVIN RD N
Second Line :
City : BELLEVUE
State : NE
Zip : 68005-4898
Country : US
Telephone Number : 402-940-7387
Fax Number : 402-702-0538
Provider Business Practice Location Address
First Line : 207 GALVIN RD N
Second Line :
City : BELLEVUE
State : NE
Zip : 68005-4898
Country : US
Telephone Number : 402-929-4372
Fax Number : 402-702-0538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2021
Last Update Date : 03/16/2026

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