Active NPI
Sandra Luann Peterson, LICSW
- Clinical Social Worker
- Thief River Falls, MN
National Provider Identifier
1053307025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4847
- Practice address
- 120 Labree Ave S
Northwest Medical Center
Thief River Falls, MN 56701-2819 - Phone
- (218) 681-4240
- Fax
- (218) 681-5614
- NPI assigned
- Sep 23, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4847 | MN | Primary |
Addresses
Primary practice location
120 Labree Ave S
Northwest Medical Center
Thief River Falls, MN 56701-2819
Mailing address
21078 115TH Ave NE
Thief River Falls, MN 56701-9313
Phone (218) 681-3658
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09493300 | Medicaid | MN | |
| 336L2PE | Other | MN | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4847 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1053307025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21078 115TH AVE NE",
"city": "THIEF RIVER FALLS",
"state": "MN",
"postal_code": "567019313",
"telephone_number": "218-681-3658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 LABREE AVE S",
"address_2": "NORTHWEST MEDICAL CENTER",
"city": "THIEF RIVER FALLS",
"state": "MN",
"postal_code": "567012819",
"telephone_number": "218-681-4240",
"fax_number": "218-681-5614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "SANDRA",
"middle_name": "LUANN",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-23",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "4847",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09493300",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "336L2PE",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Thief River Falls, MN
- Pennington & Red Lake County Public Health & Home Care
- Pennington County Human Services
- Pennington Health Services (Thief River Care Center)
- Beth Peterick, NP-C
- Courtney M Peters, LPC-S, LAPC
- Scott W Petrescue, MD
- Jennifer Rose Porter, PMHNP
- Kurt W Possai, DO
- Premise Health of Tennessee Medical PC (Digi-Key Health and Wellness Center)
- Kayla R Putzke
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.