Jessica Ann Peterson, LICSW, CSW-PIP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

20365 Issued in MN

Practice address

1585 Thomas Center Dr
Ste 104
Eagan, MN 55122-3039

Phone

(763) 560-0900

NPI assigned

May 24, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547424000000",
    "number": "1497966238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6485 134TH ST W",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247917",
            "telephone_number": "952-303-1856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1585 THOMAS CENTER DR",
            "address_2": "STE 104",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551223039",
            "telephone_number": "763-560-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "LICSW, CSW-PIP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-24",
        "last_updated": "2019-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "4550",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SD",
            "license": "3028",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "20365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheri Lynn Petersen, LPCC
• Peterson Counseling and Supervision, LLC
• Anna Peterson
• Ashley Julian Peterson
• Gerald Frederick Peterson, MD
• Jimmie Ray Peterson
• Megan Peterson, OTR/L
• Kallie Petricka, OTR/L
• Pettis Chiropractic
• Jay L. Pettis, D.C.

• Clinical Social Worker in Eagan, MN
• Providers in Eagan, 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 Jan 14, 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.