Individual
JOHN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1833 3RD AVE, ANOKA, MN 55303-2424
(763) 421-5535
Mailing address
5373 JACKSON DR, SAINT PAUL, MN 55112-1445
(612) 910-3558
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
MN
Other
Enumeration date
10/07/2010
Last updated
06/23/2011
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