Provider Demographics
NPI:1326027244
Name:PETERSON, STEVEN P (MS, LP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:1230 E MAIN ST MANKATO CLINIC LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:MADISON EAST CENTER
Practice Address - Street 2:SUITE 352 MANKATO CLINIC DEPARTMENT OF PSYCHIATRY
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-387-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2984103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN114944OtherUCARE
410849339 56001 C027OtherCHAMPUS
MNNA2951012523OtherPREFERRED ONE
MN248L7PEOtherBCBS
MN2409705OtherAMERICAS PPO
MN714563200Medicaid
MNHP28644OtherHEALTH PARTNERS