| Doctor Name: | JOHN PETERSON |
| NPI Number: | 1245549344 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1833 3rd Ave Anoka, MN - 553032424 |
| Business Phone Number: | 7634215535 |
| Business Fax Number: | |
| Mailing Address: | 5373 Jackson Dr, SAINT PAUL |
| State: | MN |
| Postal Code: | 551121445 |
| Phone Number: | 6129103558 |
| Fax Number: | |
| NPI Enumeration Date: | 10/07/2010 |
| NPI Last Update Date: | 06/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| 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 |