Individual
MRS. GLORIA DEAN SCALES PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
3333 NORTH 4TH STREET, MINNEAPOLIS, MN 55412
(612) 239-7119
(612) 632-8653
Mailing address
P.O. BOX 22305, ROBBINSDALE, MN 55422-9998
(612) 239-7119
(612) 632-8653
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3696
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04931550
MEDICAL ASSISTANCE
MN
05
—
6220443
—
MN
Enumeration date
09/19/2007
Last updated
07/21/2022
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