| Doctor Name: | BRENDEN PETERSON |
| NPI Number: | 1114319860 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 7101004661 |
| Business Practice Address: | 1000 E Tinkham Ave Ludington, MI - 494311568 |
| Business Phone Number: | 2318456291 |
| Business Fax Number: | |
| Mailing Address: | 917 W Cross St Apt 3, YPSILANTI |
| State: | MI |
| Postal Code: | 481972758 |
| Phone Number: | 2692510314 |
| Fax Number: | |
| NPI Enumeration Date: | 03/03/2015 |
| NPI Last Update Date: | 03/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 7101004661 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| 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 |