Individual
DR. DONNA SUE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D, LP
Contact information
Practice address
13045 FALCON DR, SUITE 100, BAXTER, MN 56425-4201
(218) 829-9307
(218) 829-7649
Mailing address
PO BOX 1050, CROSSLAKE, MN 56442-1050
(763) 226-1954
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2983
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
938055800
—
MN
Enumeration date
07/19/2006
Last updated
02/24/2017
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