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Individual

JERRY THOMAS MATTHEW PETERSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MT-BC

Contact information

Practice address
136 SANDBAR CT NE, ROCHESTER, MN 55906-2652
(763) 415-0374
Mailing address
16620 40TH AVE N, MINNEAPOLIS, MN 55446-2687
(563) 249-5781

Taxonomy

Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary

Other

Enumeration date
05/11/2020
Last updated
05/11/2020
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