| Doctor Name: | DONNA ELLENA PETERSON |
| NPI Number: | 1013980374 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA LP |
| License Number: | 3970 |
| Business Practice Address: | 1811 Weir Dr Ste 355, Mail Stop 13701a Woodbury, MN - 55125 |
| Business Phone Number: | 6512544786 |
| Business Fax Number: | 6512288362 |
| Mailing Address: | 8100 34th Ave S, 21110q BLOOMINGTON |
| State: | MN |
| Postal Code: | 554251672 |
| Phone Number: | 9528837961 |
| Fax Number: | 9528835395 |
| NPI Enumeration Date: | 02/08/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 3970 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |