Organization
PETERSON SPEECH THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARISSA LYNNE PETERSON MA/CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(208) 757-8553
Entity
Organization
Contact information
Practice address
545 LINCOLN DR, IDAHO FALLS, ID 83401-4118
(208) 757-8553
Mailing address
545 LINCOLN DR, IDAHO FALLS, ID 83401-4118
(208) 757-8553
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/14/2013
Last updated
08/14/2013
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