Provider Demographics
NPI:1871292268
Name:JENNIFER L PETERSON
Entity type:Organization
Organization Name:JENNIFER L PETERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEDMENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-316-2001
Mailing Address - Street 1:2204 PETERSEN DR NW
Mailing Address - Street 2:
Mailing Address - City:STEWARTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55976-1680
Mailing Address - Country:US
Mailing Address - Phone:507-316-2001
Mailing Address - Fax:
Practice Address - Street 1:2204 PETERSEN DR NW
Practice Address - Street 2:
Practice Address - City:STEWARTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55976-1680
Practice Address - Country:US
Practice Address - Phone:507-316-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty