Most Relevant Information
Provider Data
| NPI Number: | 1003284886 |
| Provider Name: | STEPHEN PETERSON |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/09/2015 |
| Last Updated: | 09/09/2015 |
Provider Practice Location
7400 METRO BLVD STE 220
EDINA
MN
554392321
Practice Location Phone/Fax
| Phone: | 9522207164 |
| Fax: |
Provider Mailing Location
8630 QUEEN AVE S
BLOOMINGTON
MN
554311904
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |