Provider Demographics
NPI:1962381624
Name:PETERSON-HILLEQUE, VICTORIA (LP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:PETERSON-HILLEQUE
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 77TH ST W STE 370
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4912
Mailing Address - Country:US
Mailing Address - Phone:612-464-1400
Mailing Address - Fax:
Practice Address - Street 1:4600 77TH ST W STE 370
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4912
Practice Address - Country:US
Practice Address - Phone:612-464-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP7225103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical