Provider Demographics
NPI:1144992520
Name:PETERSEN, JENNIFER R (LPCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:DUNNELL
Mailing Address - State:MN
Mailing Address - Zip Code:56127-4006
Mailing Address - Country:US
Mailing Address - Phone:612-968-4725
Mailing Address - Fax:
Practice Address - Street 1:230 KNOX ST S
Practice Address - Street 2:
Practice Address - City:ALPHA
Practice Address - State:MN
Practice Address - Zip Code:56111-4006
Practice Address - Country:US
Practice Address - Phone:507-407-9775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2025-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21522101YP2500X
MN4424101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional