Provider Demographics
NPI:1164086450
Name:PETERSON, AIMEE E (CSW-PIP)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:E
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E 69TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8322
Mailing Address - Country:US
Mailing Address - Phone:605-215-4364
Mailing Address - Fax:
Practice Address - Street 1:1601 E 69TH ST STE 206
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8322
Practice Address - Country:US
Practice Address - Phone:605-215-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN620881041C0700X
SD50501041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1164086450Medicaid
SD1477179919Medicaid