Individual
KRISTEN K PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
5219 88TH AVE, KENOSHA, WI 53144-7468
(262) 653-0850
Mailing address
31531 BEAR ARBOR DR, 208, BURLINGTON, WI 53105-7200
(262) 653-0850
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2668-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42568600
—
WI
Enumeration date
01/05/2007
Last updated
07/09/2007
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