Individual
DIANE M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1313 30TH AVE S, MOORHEAD, MN 56560-5106
(218) 284-3713
Mailing address
1313 30TH AVE S, MOORHEAD, MN 56560-5106
(218) 284-3713
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10002592
MN
235Z00000X
Speech-Language Pathologist
Primary
SLP1903
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
581810
—
AZ
Enumeration date
03/30/2007
Last updated
05/05/2026
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