Individual
MRS. LACY ANNETTE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
7112 S MINGO RD, SUITE 108, TULSA, OK 74133-3201
(918) 250-7093
(918) 250-9976
Mailing address
7112 S MINGO RD, SUITE 108, TULSA, OK 74133-3201
(918) 250-7093
(918) 250-9976
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3230
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12096911
ASHA ACCOUNT NUMBER
—
Enumeration date
11/08/2006
Last updated
07/08/2007
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