Individual
CAROLYN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA-CCC,SLP
Contact information
Practice address
239 GRANNYS GARDEN RD, LIBBY, MT 59923-9218
(406) 293-7480
Mailing address
239 GRANNYS GARDEN RD, LIBBY, MT 59923-9218
(406) 293-7480
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
746
MT
235Z00000X
Speech-Language Pathologist
9140
AZ
Other
Enumeration date
10/24/2014
Last updated
10/24/2014
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