Patricia Mary Peterson

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

LP3202 Issued in MN

Practice address

1500 McAndrews Rd W
Suite 224
Burnsville, MN 55337-4432

Phone

(612) 325-4018

Fax

(952) 892-1722

NPI assigned

Dec 1, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1821166653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13657 ELKWOOD DR",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551245233",
            "telephone_number": "612-325-4018",
            "fax_number": "952-892-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 MCANDREWS RD W",
            "address_2": "SUITE 224",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374432",
            "telephone_number": "612-325-4018",
            "fax_number": "952-892-1722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PATRICIA",
        "middle_name": "MARY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MN",
            "license": "LP3202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "65D24PE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "65D25PE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sharon Joyce Petersen, L.M.F.T.
• Callie Jean Peterson
• Danette Peterson
• Kendall R Peterson, R. PH.
• Michael Gene Peterson, MD
• Sheldon Trent Peterson, DDS
• Tyler Blaine Peterson, D.D.S.
• Ariel Petracca Selk, L.AC., DACM
• Drew Pfaff, DC
• Phoenix Physical Therapy

• Cognitive & Behavioral Psychologist in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Cognitive & Behavioral Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.