MEDICARE: EMILY ANN PETERSDORFF

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	104100000X	Social Worker	135459	WI

General Provider Information

NPI Number	:	1982437695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANN PETERSDORFF

Provider Business Mailing Address
First Line	:	285 FOREST GROVE DR STE 207A
Second Line	:
City	:	PEWAUKEE
State	:	WI
Zip	:	53072-3738
Country	:	US
Telephone Number	:	608-352-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 FOREST GROVE DR STE 207A
Second Line	:
City	:	PEWAUKEE
State	:	WI
Zip	:	53072-3738
Country	:	US
Telephone Number	:	608-352-0337
Fax Number	:

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

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	06/04/2026

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Directions to “ EMILY ANN PETERSDORFF ” Practice Location

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