Doctor Name: | CAROLYN PETERSON |
NPI Number: | 1215332846 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA-CCC,SLP |
License Number: | 9140 |
Business Practice Address: | 239 Grannys Garden Rd Libby, MT - 599239218 |
Business Phone Number: | 4062937480 |
Business Fax Number: | |
Mailing Address: | 239 Grannys Garden Rd, LIBBY |
State: | MT |
Postal Code: | 599239218 |
Phone Number: | 4062937480 |
Fax Number: | |
NPI Enumeration Date: | 10/24/2014 |
NPI Last Update Date: | 10/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 9140 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
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 |