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Individual

AUDREY PETERSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CCC-SLP

Contact information

Practice address
12276 SAN JOSE BLVD STE 508, JACKSONVILLE, FL 32223-8618
(904) 886-3228
Mailing address
12276 SAN JOSE BLVD STE 508, JACKSONVILLE, FL 32223-8618
(904) 886-3228

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA15457
FL
235Z00000X
Speech-Language Pathologist
SZ7762
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
018756200
FL
Enumeration date
08/24/2016
Last updated
09/30/2021
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