Active NPI
Amanda Lynn Peterson, PHD LP
- Clinical Psychologist
- Rosemount, MN
National Provider Identifier
1508547977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP7008
- Practice address
- 15265 Carrousel Way
Rosemount, MN 55068-1760 - Phone
- (952) 443-4600
- NPI assigned
- Jul 28, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 Psychologist | 103TC0700X | LP7008 | MN | Primary |
Addresses
Primary practice location
15265 Carrousel Way
Rosemount, MN 55068-1760
Mailing address
15265 Carrousel Way
Rosemount, MN 55068-1760
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231214000107 | MN | Practitioner - Clinical Psychologist | 1153770284 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701648000000",
"number": "1508547977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15265 CARROUSEL WAY",
"city": "ROSEMOUNT",
"state": "MN",
"postal_code": "550681760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15265 CARROUSEL WAY",
"city": "ROSEMOUNT",
"state": "MN",
"postal_code": "550681760",
"telephone_number": "952-443-4600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "AMANDA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PHD LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-07-28",
"last_updated": "2023-12-04",
"certification_date": "2023-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP7008",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rosemount, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.