Doctor Name: | MISS KARRIE J PETERSEN |
NPI Number: | 1346591153 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS SLP |
License Number: | LL60302449 |
Business Practice Address: | 1600 3rd Ave Longview, WA - 986323231 |
Business Phone Number: | 3604259810 |
Business Fax Number: | 3604251053 |
Mailing Address: | 6511 Sw Firlock Way Apt 2, PORTLAND |
State: | OR |
Postal Code: | 972237946 |
Phone Number: | 5033696326 |
Fax Number: | |
NPI Enumeration Date: | 09/20/2012 |
NPI Last Update Date: | 09/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | LL60302449 |
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 |