Individual
WALLIS PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7608 E 91ST ST, TULSA, OK 74133-6014
(918) 663-0606
Mailing address
7608 E 91ST ST, TULSA, OK 74133-6014
(918) 663-0606
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
CF667
OK
Other
Enumeration date
12/11/2024
Last updated
12/11/2024
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