Doctor Name: | JODI K PETERSON |
NPI Number: | 1306196977 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | LL00003597 |
Business Practice Address: | 1900 Daniels St Hough School Vancouver, WA - 986602535 |
Business Phone Number: | 3603132100 |
Business Fax Number: | 3603132101 |
Mailing Address: | 1900 Daniels St, Hough School VANCOUVER |
State: | WA |
Postal Code: | 986602535 |
Phone Number: | 3603132100 |
Fax Number: | 3603132101 |
NPI Enumeration Date: | 09/11/2012 |
NPI Last Update Date: | 01/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | LL00003597 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
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 |