Doctor Name: | SALLY ANN PETERSON |
NPI Number: | 1568568442 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 1768 |
Business Practice Address: | 2705 Enloe St Hudson, WI - 540168173 |
Business Phone Number: | 7153862128 |
Business Fax Number: | 7153866119 |
Mailing Address: | 214 Glenmont Rd, RIVER FALLS |
State: | WI |
Postal Code: | 540228018 |
Phone Number: | 7154258975 |
Fax Number: | |
NPI Enumeration Date: | 09/16/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 1768 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
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 |