Individual
MS. NANCY JO PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC SLP
Contact information
Practice address
4635 WAVILLE RD NE, BEMIDJI, MN 56601-8983
(218) 751-2588
Mailing address
4635 WAVILLE RD NE, BEMIDJI, MN 56601-8983
(218) 751-2588
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7693
MN
Other
Enumeration date
12/31/2007
Last updated
12/31/2007
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