Donna Sue Peterson, PSY.D, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP2983 Issued in MN

Practice address

13045 Falcon Dr
Suite 100
Baxter, MN 56425-4201

Phone

(218) 829-9307

Fax

(218) 829-7649

NPI assigned

Jul 19, 2006

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

Other names 1

• Donna Sue Daiker Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487894400000",
    "number": "1346269032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1050",
            "city": "CROSSLAKE",
            "state": "MN",
            "postal_code": "564421050",
            "telephone_number": "763-226-1954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13045 FALCON DR",
            "address_2": "SUITE 100",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564254201",
            "telephone_number": "218-829-9307",
            "fax_number": "218-829-7649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DONNA",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "PSY.D, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2017-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP2983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "938055800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DONNA",
            "last_name": "DAIKER",
            "middle_name": "SUE",
            "credential": "PSY.D., L.P.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David B Pelowski, O.D.
• Jennifer Lee Perez Krueger, MSW, LGSW
• Avariel Perisian
• Rick Wayne Peters, LADC
• Brikken Ann Peterson
• Jolene Beth Peterson
• Sandra Rae Peterson
• Teri Kaminski Peterson
• Ava Pikula
• Pine Lakes Endodontics PA

• Clinical Psychologist in Baxter, MN
• Providers in Baxter, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; 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.