Individual
PATRICIA MARY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 MCANDREWS RD W, SUITE 224, BURNSVILLE, MN 55337-4432
(612) 325-4018
(952) 892-1722
Mailing address
13657 ELKWOOD DR, APPLE VALLEY, MN 55124-5233
(612) 325-4018
(952) 892-1722
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
LP3202
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
65D24PE
BLUE CROSS BLUE SHIELD
MN
01
—
65D25PE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
12/01/2006
Last updated
07/09/2007
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