Individual
BRENDEN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 E TINKHAM AVE, LUDINGTON, MI 49431-1568
(231) 845-6291
Mailing address
917 W CROSS ST APT 3, YPSILANTI, MI 48197-2758
(269) 251-0314
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101004661
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1095263920
—
MI
Enumeration date
03/03/2015
Last updated
03/03/2015
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