Provider Demographics
NPI:1629126230
Name:PETERS, JULIE ANN (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:PETERS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 28TH ST NE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-6410
Mailing Address - Country:US
Mailing Address - Phone:507-433-1843
Mailing Address - Fax:
Practice Address - Street 1:1111 28TH ST NE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-6410
Practice Address - Country:US
Practice Address - Phone:507-433-1843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5523103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist