Doctor Name: | KIM PETEKIEWICZ |
NPI Number: | 1568831188 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP-CCC |
License Number: | 41YS00806900 |
Business Practice Address: | 85 Harreton Rd Allendale, NJ - 074011317 |
Business Phone Number: | 8456429436 |
Business Fax Number: | |
Mailing Address: | 320 Arlington Ct, BARDONIA |
State: | NY |
Postal Code: | 109541651 |
Phone Number: | 8456429436 |
Fax Number: | |
NPI Enumeration Date: | 09/24/2015 |
NPI Last Update Date: | 09/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 41YS00806900 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
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 |