| Doctor Name: | MISS MARY ELIZABETH PETERSEN |
| NPI Number: | 1114938016 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. CCC-SLP |
| License Number: | SP.8246 |
| Business Practice Address: | 10701 East Blvd Audiology And Speech Pathology 126 W Cleveland, OH - 441061702 |
| Business Phone Number: | 2167913800 |
| Business Fax Number: | 2167075958 |
| Mailing Address: | 3925 W 210th St, FAIRVIEW PARK |
| State: | OH |
| Postal Code: | 441261404 |
| Phone Number: | 4405395901 |
| Fax Number: | |
| NPI Enumeration Date: | 08/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP.8246 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| 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 |