Individual
MRS. LORI ANN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 CAMPUS DRIVE, BRADFORD, PA 16701
(814) 887-5591
(814) 887-5666
Mailing address
29 PETER LANE, KANE, PA 16735
(814) 778-5966
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL006305L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011532860001
—
PA
Enumeration date
04/04/2007
Last updated
07/08/2007
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