| Doctor Name: | SANDRA LUANN PETERSON |
| NPI Number: | 1053307025 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | 4847 |
| Business Practice Address: | 120 Labree Ave S Northwest Medical Center Thief River Falls, MN - 567012819 |
| Business Phone Number: | 2186814240 |
| Business Fax Number: | 2186815614 |
| Mailing Address: | 21078 115th Ave Ne, THIEF RIVER FALLS |
| State: | MN |
| Postal Code: | 567019313 |
| Phone Number: | 2186813658 |
| Fax Number: | |
| NPI Enumeration Date: | 09/23/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 4847 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |