| Doctor Name: | MRS. JENNIFER L PETERSEN |
| NPI Number: | 1558669523 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CCC-SLP |
| License Number: | 020216-1 |
| Business Practice Address: | 53 Bedford Ave Middletown, NY - 109406414 |
| Business Phone Number: | 8453261784 |
| Business Fax Number: | |
| Mailing Address: | Po Box 255, SUMMITVILLE |
| State: | NY |
| Postal Code: | 127810255 |
| Phone Number: | 8458885411 |
| Fax Number: | |
| NPI Enumeration Date: | 03/01/2011 |
| NPI Last Update Date: | 03/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 020216-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| 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 |