Individual
MRS. LISA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
407 N FOSTER ST, CENTER, MO 63436-1026
(573) 267-3963
Mailing address
407 N FOSTER ST, PO BOX 117, CENTER, MO 63436-1026
(573) 267-3963
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0347894
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0347894
MISSOURI DEPARTMENT OF EDUCATION-TEACHING CERTIFICATE
MO
Enumeration date
08/20/2014
Last updated
08/20/2014
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