Individual
MS. MELODY R PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
2624 9TH AVE S, FARGO, ND 58103-2350
(701) 298-4500
(701) 298-4400
Mailing address
2624 9TH AVE S, FARGO, ND 58103-2350
(701) 298-4500
(701) 298-4400
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1269
ND
171M00000X
Case Manager/Care Coordinator
Primary
—
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009179
BSBS OF ND PIN
NC
Enumeration date
08/01/2006
Last updated
09/11/2025
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