Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kristin Petersen

Individual provider Clinical Social Worker · NPI 1710422779

Kristin Petersen is a Clinical Social Worker in White Earth, Minnesota. Qualified in 2012, 14 years ago. Licensed in Minnesota.

Years since qualifying
14
Licensed in
MN
In the registry since
2016
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Practice location Address checks out

26246 Crane Rd
White Earth, MN 56591-9998
Phone: (218) 983-4703
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 21218 (MN)

Record details

NPI number1710422779
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 30, 2016
Last updated in NPPESDecember 30, 2016
Mailing address6578 Big Bass Rd Ne, Bemidji, MN 56601-8674

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

Other providers in White Earth