| Organization Name: | JONATHAN G. PETERSON PSYCHIATRY, LTD. |
| NPI Number: | 1902164155 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JONATHAN G PETERSON (PRESIDENT) |
| Mailing Address: | 207 Hiawatha Dr E Wabasha |
| State: | MN US |
| Postal Code: | 559811552 |
| Phone Number: | 6515641545 |
| Fax Number: | |
| NPI Enumeration Date: | 04/25/2012 |
| NPI Last Update Date: | 05/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 33320 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |