Organization
JONATHAN G. PETERSON PSYCHIATRY, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN G PETERSON M.D. (PRESIDENT)
(651) 564-1545
Entity
Organization
Contact information
Practice address
207 HIAWATHA DR E, WABASHA, MN 55981-1552
(651) 564-1545
Mailing address
PO BOX 266, WABASHA, MN 55981-0266
(651) 564-1545
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
33320
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
888268100
—
MN
Enumeration date
04/25/2012
Last updated
05/06/2012
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