Doctor Name: | DESTINEY PETERS |
NPI Number: | 1023410032 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCC-SLP |
License Number: | 102001 |
Business Practice Address: | 200 E Debbie Ln Mansfield, TX - 760639211 |
Business Phone Number: | 8172252912 |
Business Fax Number: | |
Mailing Address: | 200 E Debbie Ln, MANSFIELD |
State: | TX |
Postal Code: | 760639211 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/22/2014 |
NPI Last Update Date: | 09/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 102001 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |