Individual
MS. BONNIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1451 44TH AVE S, GRAND FORKS, ND 58201-3434
(701) 775-2500
(701) 787-8996
Mailing address
1451 44TH AVE S, PO BOX 14545, GRAND FORKS, ND 58201-3434
(701) 775-2500
(701) 787-8996
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
11620
MN
1041C0700X
Clinical Social Worker
Primary
2024
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02T25RI
MN BC/BS
MN
01
—
14785
ND BC/BS
ND
05
—
562323500
—
MN
Enumeration date
04/20/2006
Last updated
07/27/2010
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