Individual
STEVEN P PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LP
Contact information
Practice address
MADISON EAST CENTER, SUITE 352 MANKATO CLINIC DEPARTMENT OF PSYCHIATRY, MANKATO, MN 56001
(507) 387-3195
Mailing address
PO BOX 8674, 1230 E MAIN ST MANKATO CLINIC LTD, MANKATO, MN 56002-8674
(507) 625-1811
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2984
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114944
UCARE
MN
01
—
2409705
AMERICAS PPO
MN
01
—
248L7PE
BCBS
MN
01
—
410849339 56001 C027
CHAMPUS
—
05
—
714563200
—
MN
01
—
HP28644
HEALTH PARTNERS
MN
01
—
NA2951012523
PREFERRED ONE
MN
Enumeration date
01/10/2006
Last updated
07/15/2020
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