Individual
MRS. BETTY B. PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
153 SHORE RD, PATCHOGUE, NY 11772-2559
(631) 207-5875
Mailing address
153 SHORE RD, PATCHOGUE, NY 11772-2559
(631) 207-5875
Taxonomy
Speciality
Code
Description
License number
State
235500000X
Speech/Language/Hearing Specialist/Technologist
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SSN
TEACHER CERTIFICATION
NY
Enumeration date
12/17/2018
Last updated
06/11/2019
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