Individual
KASSANDRA KAY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
1833 3RD AVE, ANOKA, MN 55303-5353
(651) 748-5019
(651) 773-7591
Mailing address
1833 3RD AVE, ANOKA, MN 55303-2424
(763) 421-5535
(763) 433-0226
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386961001
—
MN
Enumeration date
04/21/2010
Last updated
12/11/2019
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