Kassandra Kay Peterson, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

1833 3Rd Ave
Anoka, MN 55303-5353

Phone

(651) 748-5019

Fax

(651) 773-7591

NPI assigned

Apr 21, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Kassandra Dallmann Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Family Innovations, Inc.

  • Counseling Psychologist
  • Anoka, MN
  • NPI 1992862783

  Clinical

  NPD

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

{
    "created_epoch": "1271808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1386961001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 3RD AVE",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553032424",
            "telephone_number": "763-421-5535",
            "fax_number": "763-433-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1833 3RD AVE",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553035353",
            "telephone_number": "651-748-5019",
            "fax_number": "651-773-7591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KASSANDRA",
        "middle_name": "KAY",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-21",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386961001",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KASSANDRA",
            "last_name": "DALLMANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kathryn Perovich
• Personal Care Senior Living, LLC
• Peterson Shoe Inc
• Fatuma K Peterson
• John Peterson
• Trenton Jon Peterson, MA, LMFT, LADC
• Alicia Petroff
• Michelle Pettit, MA OTR/L
• Rachel Lillian Pfahning, DDS
• Margaret Susan Pfau, LMFT

• Clinical Social Worker in Anoka, MN
• Providers in Anoka, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; 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.