Provider Demographics
NPI:1295554004
Name:PETERSON, AMANDA FLOWERS
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:FLOWERS
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9051 DEGLER CIR
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4836
Mailing Address - Country:US
Mailing Address - Phone:530-276-1716
Mailing Address - Fax:
Practice Address - Street 1:905 JEFFERSON AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-4740
Practice Address - Country:US
Practice Address - Phone:612-562-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health