Provider Demographics
NPI:1457984684
Name:PETERSEN, MARGARET ROSE (MA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ROSE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 BRISTOL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-2561
Mailing Address - Country:US
Mailing Address - Phone:763-477-1318
Mailing Address - Fax:
Practice Address - Street 1:7801 E BUSH LAKE RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55439-3120
Practice Address - Country:US
Practice Address - Phone:763-477-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health