Jonathan G. Peterson Psychiatry, LTD.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

33320 Issued in MN

Legal business name

JONATHAN G. PETERSON PSYCHIATRY, LTD.

Practice address

207 Hiawatha Dr E
Wabasha, MN 55981-1552

Phone

(651) 564-1545

NPI assigned

Apr 25, 2012

Organization subpart

No

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

Authorized official

Name

Jonathan G Peterson, M.D.NPI 1003882010

Title

President

Phone

(651) 564-1545

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jonathan Peterson, M.D.

  • Geriatric Psychiatry Physician
  • Wabasha, MN
  • NPI 1003882010
  NPD (past) Authorized official

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336262400000",
    "number": "1902164155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 266",
            "city": "WABASHA",
            "state": "MN",
            "postal_code": "559810266",
            "telephone_number": "651-564-1545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 HIAWATHA DR E",
            "city": "WABASHA",
            "state": "MN",
            "postal_code": "559811552",
            "telephone_number": "651-564-1545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONATHAN G. PETERSON PSYCHIATRY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-25",
        "last_updated": "2012-05-06",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-564-1545",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "33320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "888268100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John F Hust, RN, CRNA
• Lisa Mae Jaeger, LPC
• Kent Shepard Jeffery, MD
• Katlyn Jo Jessen, LPCC
• JL Walsh PA
• Brian E. Kelly, MD
• Camilla Lynn Kohutko, PT
• Marlene Kosobucki, PT
• Laura McKenzie Lara, MD
• LC Edelbach Company LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Wabasha, MN
• Providers in Wabasha, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2012; 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.