Provider Demographics
NPI:1831337120
Name:MONTGOMERY-PETERSON, JANEEN (PSY D, LP)
Entity type:Individual
Prefix:MRS
First Name:JANEEN
Middle Name:
Last Name:MONTGOMERY-PETERSON
Suffix:
Gender:F
Credentials:PSY D, LP
Other - Prefix:
Other - First Name:JANEEN
Other - Middle Name:
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY D, LP
Mailing Address - Street 1:7270 FORESTVIEW LN N STE 150
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5568
Mailing Address - Country:US
Mailing Address - Phone:763-416-4167
Mailing Address - Fax:763-416-4137
Practice Address - Street 1:7270 FORESTVIEW LN N STE 150
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5568
Practice Address - Country:US
Practice Address - Phone:763-416-4167
Practice Address - Fax:763-416-4137
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4750103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist