Judith Marie Peters, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3425 Issued in MN

Practice address

157 Roosevelt Rd
Suite 300
Saint Cloud, MN 56301-5478

Phone

(320) 240-3324

Fax

(320) 240-3339

NPI assigned

May 18, 2009

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)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Catholic Charities of the Diocese of St. Cloud

  • Adult Mental Health Clinic/Center
  • Saint Cloud, MN
  • NPI 1003944620
  NPD (past)

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

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242604800000",
    "number": "1205061488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2390",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563022390",
            "telephone_number": "320-650-1544",
            "fax_number": "320-650-1528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 ROOSEVELT RD",
            "address_2": "SUITE 300",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563015478",
            "telephone_number": "320-240-3324",
            "fax_number": "320-240-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "JUDITH",
        "middle_name": "MARIE",
        "credential": "LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-18",
        "last_updated": "2009-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470024400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Holly Bacon Perkins, M.D.
• Alissa Marie Perry, SLP
• Stephanie Lynn Peschl, LPN
• Penny Jennifer Pesta, MSW LICSW
• Cheryl Phyllis Peters-Lewis, LADC
• Andrea Margo Petersen, APRN, CNP
• Ethan Petersen, CRNA
• Rachel Petersen, PSY.D.
• Rebecca A Petersen, CRNA
• Peterson Dental Associates, P.a.

• Psychologist in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2009; 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.