Individual
COLE CHRISTIAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
530 E 2ND ST, DULUTH, MN 55805-1913
(218) 786-5360
Mailing address
530 E 2ND ST, DULUTH, MN 55805-1913
(218) 786-5360
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7264
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42787800
—
WI
01
—
4600610
MEDICA
—
Enumeration date
07/14/2006
Last updated
07/08/2007
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