Provider Demographics
NPI:1609602440
Name:PETERSEN, SHERI LYNN (LPCC)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:LYNN
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:SHERI
Other - Middle Name:LYNN
Other - Last Name:KRUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3460 WASHINGTON DR STE 109
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4301
Mailing Address - Country:US
Mailing Address - Phone:651-560-0050
Mailing Address - Fax:
Practice Address - Street 1:3460 WASHINGTON DR STE 109
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4301
Practice Address - Country:US
Practice Address - Phone:651-560-0050
Practice Address - Fax:651-925-0257
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN4564101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health