Provider Demographics
NPI:1619723368
Name:VELLEUX, PETER ANDREW
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANDREW
Last Name:VELLEUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8763 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7402
Mailing Address - Country:US
Mailing Address - Phone:612-297-5607
Mailing Address - Fax:
Practice Address - Street 1:8763 DEER PATH
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7402
Practice Address - Country:US
Practice Address - Phone:612-297-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker