Jolene Peterson, MSW LCSW PIP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1265 Issued in SD

Practice address

3200 Canyon Lake Dr
Rapid City, SD 57702-8114

Phone

(605) 355-2215

Fax

(605) 355-2504

NPI assigned

Apr 13, 2006

Last updated

Apr 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649635200000",
    "number": "1033173349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 CANYON LAKE DR",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577028114",
            "telephone_number": "605-355-2215",
            "fax_number": "605-355-2504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CANYON LAKE DR",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577028114",
            "telephone_number": "605-355-2215",
            "fax_number": "605-355-2504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JOLENE",
        "credential": "MSW LCSW PIP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-13",
        "last_updated": "2022-04-11",
        "certification_date": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SD",
            "license": "1265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "554090",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Petersen
• Alexis Peterson
• Calista Peterson
• Casey H Peterson, MS
• Cassidy Peterson, PA-C
• Joudly Peterson
• Megan Peterson
• Natalie Peterson, CNP
• Randee Peterson
• Scott Peterson, PHARM. D.

• Clinical Social Worker in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Clinical Social Worker in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.