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Contact Information

PAMELA M PETERSON, PHD, LP
314 DEVIN DRIVE
SAINT CHARLES, MN55972
 Phone: 507-421-1064
 Fax: 507-932-8556
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for PAMELA M PETERSON · (Female)

NPI Number 1972674091
Status Active
Credentials PHD, LP
Entity Individual
Enumeration date 11/11/2006
Last updated 04/11/2019 - About 7 years ago
Sole proprietor 1 Yes
Identifiers
  • MN License # LP3975
  • MN Medicaid 607316600
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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