Provider Demographics
NPI:1316730567
Name:PEITERSEN, KATHERINE MARY-HANTON (LICSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY-HANTON
Last Name:PEITERSEN
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 1:9555 LAKEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-9369
Mailing Address - Country:US
Mailing Address - Phone:952-607-7467
Mailing Address - Fax:
Practice Address - Street 1:9555 LAKEWOOD CIR
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-9369
Practice Address - Country:US
Practice Address - Phone:952-607-7467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN142701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical