Individual
MRS. JULIE ANN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2595
(651) 254-1440
Mailing address
640 JACKSON ST, MAILSTOP 11303C, SAINT PAUL, MN 55101-2595
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305271
MN
Other
Enumeration date
02/21/2019
Last updated
09/20/2024
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