Provider Demographics
NPI:1881414753
Name:PETERSON, ASHLEY MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 N 3RD AVE W STE 310
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1614
Mailing Address - Country:US
Mailing Address - Phone:218-722-2368
Mailing Address - Fax:218-727-2427
Practice Address - Street 1:5 N 3RD AVE W STE 310
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1614
Practice Address - Country:US
Practice Address - Phone:218-722-2368
Practice Address - Fax:218-727-2427
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health