Individual
JIMMIE RAY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2085 JADE LN, EAGAN, MN 55122-2862
(612) 619-1047
Mailing address
2085 JADE LN, EAGAN, MN 55122-2862
(612) 619-1047
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
01/21/2022
Last updated
01/21/2022
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