Individual
JENNIFER MARIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LADC
Contact information
Practice address
1246 UNIVERSITY AVE W, SAINT PAUL, MN 55104-4125
(612) 286-1407
Mailing address
1246 UNIVERSITY AVE W, SAINT PAUL, MN 55104-4125
(612) 286-1407
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305381
MN
Other
Enumeration date
11/13/2020
Last updated
11/13/2020
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